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Prov Contract/CofC Analyst or Analyst Senior-PS18664

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Job Details
Job Order Number
JC137867526
Company Name
Anthem, Inc
Physical Address

Topeka, KS 66612
Job Description

Prov Contract/CofC Analyst or Analyst Senior-PS18664

Location: Atlanta, Georgia, United States

Field: Reporting & Data Analysis

Requisition #: PS18664

Post Date: Apr 10, 2019

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.

Preferred Locations:

Atlanta,GA but will consider any Anthem location:

PROVIDER CONTRACT/COST OF CARE ANALYST OR ANALYST SENIOR

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. 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.

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

3. Recommends standardized practices to optimize cost of care.

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

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

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

Additionally: Ability to independently perform 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; writing basic SQL and/or SAS code and analyzing large data sets;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.

• Participates in quality review of work product from lower level analysts or peers

• Participates in the onboarding of new associates by allowing job shadowing when necessary

PROVIDER CONTRACT/COST OF CARE ANALYST or SENIOR

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

+ 2-5 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 required.

+ Microsoft Office Excel – Advanced proficiency required.

+ SAS preferred.

+ Master’s degree preferred.

+ Experience with Advanced Medical Coding, ICD9/ICD10, CPT/HCPCS/Rev codes, preferred.

+ Experience with DBGs, contracting and contract modeling preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran.


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