Description
SHIFT: Day Job
SCHEDULE: Full-time
Your
Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re
creating greater access to care for our members, greater value for our
customers, and greater health for our communities. Join us and together we will
drive the future of health care.
Prefer this person be located in Chicago, IL or
Denver, CO but will consider other Anthem locations. This role is not
remote.
- The Director Provider
Economics directs the development, maintenance and
measurement of provider networks both from an internal and external
perspective, and provides expert advice and analytic support to local and
national Provider Solutions.
- Performs complex
valuations of alternative network designs to determine optimal provider
selection and forecasted performance of that network relative to targeted cost,
quality and access goals.
- Creates network
dashboards to monitor the performance of provider networks.
- Provides insights
into new network design and existing network refresh strategies
- Develops
Competitive Intelligence solutions to evaluate Anthem’s reimbursement levels
relative to other carriers at a market, network and provider level.
- Consults with
local markets on the effective use of competitive intelligence data to support
optimal contracting outcomes.
Primary
duties may include, but not limited to:
- Prepares
healthcare cost analysis to identify new, innovative strategies to control
costs.
- Performs complex
fee modeling exercises.
- Communicates fee
strategies both internally and externally to manage provider expectations.
- Prepares
negotiation prep analysis to support development of negotiation strategy.
- Evaluates cost
impact of various negotiation proposals.
- Provides analytic
support during complex provider negotiations.
- Provides day to
day negotiation support for national ancillary providers (lab, dialysis, etc).
- Hires, trains,
coaches, counsels, and evaluates performance of direct reports.
Qualifications
Requires:
- BA/BS degree in
Business or related field.
- 5+ years
experience in broad-based analytical, managed care payor or provider
environment.
- Experience in statistical analysis; or any
combination of education and experience, which would provide an equivalent
background.
- CPA or MBA preferred.
- Experience leading teams in a managed care payor
or provider environment preferred.
- In-depth knowledge of evaluating provider network
performance from a cost and quality standpoint preferred.
- In-depth knowledge of provider profiling
methodologies to evaluate cost and quality (i.e. case-mix adjusted cost per
service, ETG, DxCG) preferred
- In-depth knowledge of Medicare and Medicaid reimbursement
methodologies preferred.
- Experience with Microsoft Excel, SAS, SQL and
Tableau preferred
Anthem, Inc. is ranked as one of America’s Most Admired
Companies among health insurers by Fortune magazine and has been named a 2019
Best Employers for Diversity by Forbes. To learn more about our company and
apply, please visit us at careers.antheminc.com. An
Equal Opportunity Employer/Disability/Veteran.