Anthem, Inc. Provider Contract/Cost of Care Consultant in Palo Alto, 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 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
Location: Work at Home- Denver Colorado area* (with felixbility to work in the office a few times a month- once the office re-opens)
*Willing to consider other locations within the Mountain and Pacific Time Zones
Status: Fulltime, Salary
The Provider Contract/Cost of Care Consultant provides analytical support to the Cost of Care and/or Provider Contracting organizations. This particular position / role focuses on Facility Chargemaster monitoring and enforcement across the west Anthem markets (CA, CO and NV). The selected candidate will work closely with both the Enterprise Chargemaster Enforcement Unit and their Chargemaster Analyst colleagues across other Anthem markets. Focuses efforts on Facility Chargemaster Analytics using both the mode and average mathematical approaches while supporting the Cost of Care Team to enforce contract language as it relates to Chargemaster adjustments. Provides expert advice, analytical and consultative support to Regional VP’s and Directors on the Chargemaster Enforcement Team, Healthcare Analytical Team as well as Provider Solutions Team. Works on large scale initiatives with high dollar cost savings opportunities. Collaborates with provider contractors, the Chargemaster Enforcement Unit, and other Chargemaster Analyst’s to identify savings opportunities and enforce facility contract language. 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 and resources to identify Facility Chargemaster violations and make appropriate adjustments to neutralize Facility reimbursement.
Types of analyses include performing sophisticated Facility Chargemaster analytics using both a mean and mode mathematical approach; working with Facility Chargemaster revenue and usage reports; analyzing large data sets; building new and modifying existing complex Chargemaster models to create predictive impact decision making tools; understanding how facilities can manipulate their Chargemaster to maximize patient revenue in Anthem’s contracts; and performing both retrospective claims adjustments and prospective rate adjustments to recoup Anthem overpayments related to Chargemaster violations.
Identifies cost of care savings opportunities by identifying Facility Chargemaster violations and implementing fixes that support our contractual language.
Be familiar with various Commercial reimbursement methodologies and how Chargemaster changes can impact the contracted allowed amount.
Recommends policy changes related to Facility Chargemaster language and claim's system adjustments 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 Chargemaster 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 Facility Chargemaster / Revenue Usage analytics, managed care payor or provider environment.
Considerable experience in statistical analysis and healthcare modeling
Any combination of education and experience, which would provide an equivalent background.
Extensive experience with MS Excel required as well as a working knowledge of SAS for data query
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.
At this time, Anthem will not sponsor a new applicant for employment authorization for this position.