Anthem, Inc. Provider Contract/Cost of Care Consultant in Alexandria, Virginia
SHIFT: Day Job
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 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.
Title: Provider Contract/Cost of Care Consultant
Preferred Locations: Virginia near an Anthem office
(Other locations will be considered) - must live within 40 miles of the Anthem office
Status: Full-time, Salary, Bonus Potential
The Provider Contract/Cost of Care Consultant 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:
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.
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;
3-5 years’ experience in broad-based analytical, managed care payor or provider environment; experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
Hands on experience with Excel, Access and SQL
Hands on experience with SAS is highly desired
Master's degree 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.