Provider Contract/Cost of Care Analyst Sr
DescriptionSHIFT: Day Job
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.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Provides analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. Typically works with one provider type, e.g. physician, ancillary, or medical group. Provides advice and analytic support to Medical Directors, contract negotiators and management on cost of care issues to help reduce costs without compromising quality of care.
Primary duties may include, but are not limited to:
- Analyzes and presents data related to medical trends in coordination and collaboration with Finance and Enterprise partners.
- Summarizes performance using appropriate analytics and tools.
- Develops business performance reports using claims data that tells the drivers behind medical trends.
- Creates and publishes standard and ad hoc reports.
- Performs varied data analyses which may include:
- Developing moderately complex ROI models and performs healthcare cost analysis to identify strategies to control costs;
- Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis;
- Preparing pre-negotiation analyses to support development of defensible pricing strategies;
- performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic;
- Measuring and evaluating the cost impact of various negotiation proposals;
- Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates;
- projecting different cost of savings targets based upon various analytics.
- Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings.
- Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable. Recommends standardized practices to optimize cost of care.
- Educates provider contractors on contracting analytics from a financial impact perspective. May recommend alternative contract language and may go on-site to provider premises during contract negotiations.
- Participates on project team involved with enterprise wide initiatives.
- Requires BS/BA degree in Mathematics, Statistics, or related field and a minimum of 3 years experience in broad-based analytical, managed care payor or provider environment as well as experience in statistical analysis and healthcare modeling; or any combination of education and experience which would provide an equivalent background.
- Requires ability to write SQL queries and have advanced Excel skills. Must have experience manipulating large relational databases. Experience with healthcare data preferred.
- Master's degree preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.