Anthem, Inc. Cost of Care Analyst Senior/Consultant in Anaheim, California
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
* Please note this positon can be filled as either a Provider Contract Cost of Care Analyst Sr or Consultant level. Determined at the Hiring Mangaer's discretion*
Preferred Locations - Illinois, Indiana, Georgia, New York, Kentucky, California, Florida
This position supports the design, maintenance and measurement of Anthem’s provider networks, in addition to assessing the competitiveness of our provider contracts; critical items tied to key enterprise goals related to High Performance Networks (HPNs) and unit-price trend targets. 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. Provides expert advice, analytic and consultative support throughout network design and measurement activities. Works on large-scale initiatives with high dollar cost savings opportunities. Partners with provider contractors, local Sales teams and segment leadership 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 in the assessment of competitiveness of Anthem’s provider contracts. Works on complex enterprise-wide initiatives and acts as project lead. Primary duties may include, but are not limited to:
Uses analytic tools to to inform provider selection in new network designs and quantify changes in cost, quality and access for alternative network designs.
Projects cost changes in medical services of alternative network designs by using various analytic techniques
Performs sophisticated retrospective data analytics to assess network performance; building new and modifying existing complex models to create predictive impact decision making tools
Recommends modifications to existing algorithms and methodologies, as applicable
Preparing pre-negotiation analysis to support development of defensible pricing strategies
Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates
Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures.
Educates provider contractors on contracting analytics from a financial impact perspective.
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 3-5 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.
Master's degree preferred.
SQL experience required.
SAS and Python experience preferred.
In-depth knowledge of evaluating provider network performance from a cost and quality standpoint preferred.
In-depth knowledge of provider profiling methodologies to evaluate cost and quality (i.e. case-mix adjusted cost per service, ETG, DxCG) preferred
In-depth knowledge of Medicare and Medicaid reimbursement methodologies preferred.
Experience in analyzing Coordination of Benefit (COB) data preferred.
In-depth knowledge of recent CMS Price Transparency regulations 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.
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. An Equal Opportunity Employer/Disability/Veteran