Provider Contract/Cost of Care Analyst or Sr - 121974SK
Location:
Columbus, Georgia
Posted:
October 08, 2016
Position Type:
Full Time
Category:
Analyst
Reference:
682631640
Your Talent. Our Vision.At Anthem, Inc.,it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us andtogether 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 benefits companies and a Fortune Top 50 Company.

Location:
Thousand Oaks or Woodland Hills, CA
Denver, CO
Mason, OH
Minnetonka, MN
Chicago, IL
Richmond or Virginia Beach, VA
New York City, NY
Columbia, MD
Wallingford, CT
Atlanta, GA

PROVIDER CONTRACT/COST OF CARE ANALYST

Job Summary:

Provides analytic support to higher level Analysts and Consultants in helping them run their programs and/or to support the contracting process.

Primary duties may include, but are not limited to:

1. Modifies existing analytical models to create predictive impact decision
making tools and may build new models with assistance from higher level
Analysts and Consultants as needed.

2. Performs varied data analyses which may include:
post implementation analyses;

retrospective data analyses;

analyses to track both health risks and compliance which are critical means of managing long-term health costs;

analyses to identify cost increases in medical services;

analyses of practice patterns in relation to office visits, referral practices, and specialty care procedures to help identify strategies to control costs;

pre-negotiation analysis to support development of defensible pricing strategies;

and the measurement of the cost impact of various negotiation proposals to better forecast how pricing changes could affect the company's bottom line.
3. May map disparate sources of data to a common language for analysis.
4. May work on projects as assigned.

PROVIDER CONTRACT/COST OF CARE ANALYST SR

Job Summary:

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:

1. 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; and projecting different cost of savings targets based upon various analytics.

2. 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.

3. Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.

4. Recommends standardized practices to optimize cost of care.

5. Educates provider contractors on contracting analytics from a financial impact perspective.

6. May recommend alternative contract language and may go on-site to provider premises during contract negotiations.

7. Participates on project team involved with enterprise wide initiatives.

PROVIDER CONTRACT/COST OF CARE ANALYST
1.

Requires BS/BA degree in Mathematics, Statistics, or related field.

2-4 years experience in broad-based analytical, managed care payor or provider environment; experience in statistical analysis and healthcare modeling.

Any combination of education and experience, which would provide an equivalent background.

SQL experience required.

Excel experience required.

SAS experience preferred.

Medicaid experience preferred.

Master's degree preferred.

PROVIDER CONTRACT/COST OF CARE ANALYST SR

//

Requires BS/BA degree in Mathematics, Statistics, or related field.

3-5 years experience in broad-based analytical, managed care payor or provider environment; experience in statistical analysis and healthcare modeling.

Any combination of education and experience, which would provide an equivalent background.

SQL experience required.

Excel experience required.

SAS experience preferred.

Medicaid experience preferred.

Master's degree preferred.

/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./

Job Reporting & Data Analysis

Title: Provider Contract/Cost of Care Analyst or Sr - 121974SK

Location: GA-Columbus

Requisition ID: 121974
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