Provider Contract/Cost of Care Analyst Sr
Company: Anthem, Inc
Posted on: May 9, 2022
SHIFT: Day Job
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who
are passionate about making an impact on our members and the
communities we serve. You will thrive in a complex and
collaborative environment where you take action and ownership to
solve problems and lead change. Do you want to be part of a larger
purpose and an evolving, high-performance culture that empowers you
to make an impact?
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
+ 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
+ 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. 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. The
health of our associates and communities is a top priority for
Anthem. We require all new candidates to become vaccinated against
COVID-19. If you are not vaccinated, your offer will be rescinded
unless you provide - and Anthem approves - a valid religious or
medical explanation as to why you are not able to get vaccinated
that Anthem is able to reasonably accommodate. Anthem will also
follow all relevant federal, state and local laws. Anthem, Inc. has
been named as a Fortune Great Place To Work in 2021, is ranked as
one of the 2021 World's Most Admired Companies among health
insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on
Diversity and Inclusion. To learn more about our company and apply,
please visit us at careers.antheminc.com. Anthem is an Equal
Employment Opportunity employer and all qualified applicants will
receive consideration for employment without regard to age,
citizenship status, color, creed, disability, ethnicity, genetic
information, gender (including gender identity and gender
expression), marital status, national origin, race, religion, sex,
sexual orientation, veteran status or any other status or condition
protected by applicable federal, state, or local laws. Applicants
who require accommodation to participate in the job application
process may contact firstname.lastname@example.org for assistance.
Keywords: Anthem, Inc, Reston , Provider Contract/Cost of Care Analyst Sr, Professions , Reston, Virginia
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