Provider Contract/Cost of Care Consultant PS27592 (Preferred Location Virginia Beach, VA)
Location: United States
Requisition #: PS27592
Post Date: 8 hours ago
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 benefits companies and a Fortune Top 50 Company.
Preferred Locations: Virgina Beach, VA preferred but will consider Indianapolis, IN, Mason, OH, or Atlanta, GA.
Provider Contract/Cost of Care Consult (PS27592)
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. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works on large scale initiatives with high dollar cost savings opportunities. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.
Primary duties may include, but are not limited to:
- Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process. Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex models to create predictive impact decision making tools; performing 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 analysis 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; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projects 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.
- 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.
- Acts as a source of direction, training and guidance for less experienced staff.
- Requires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years' experience in broad-based analytical, managed care payor or provider environment, considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
- SQL required.
- SAS preferred.
- Microsoft Office Excel - Advanced proficiency required.
- Experience with hospital charge masters, understanding of how to adjust charges and impacts on reimbursement preferred.
- Master's degree preferred.
- Understanding of provider reimbursement strongly preferred.
An Equal Opportunity Employer/Disability/Veteran