Vacancy expired!
Description SHIFT: Day Job
SCHEDULE: Full-timeYour 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. Position located in Virginia Beach, VA; Mason, OH; Atlanta, GA; Indianapolis, IN or other Anthem location 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 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. This Provider Contract/Cost of Care Analyst, Sr. will be responsible for reporting and analysis for Medicaid plans providing all analytical needs. You will create and interpret reports, ad hoc reporting, drill down analysis to support performance management and evaluation health management cost of care initiatives. Responsible for estimating and monitoring and providing analytical support. Strong relationship with Medicaid Regional Leadership including regional Presidents, Finance VP, Medical Directors, etc. 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;
- 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.
- Recommends standardized practices to optimize cost of care.
- Participates on project team involved with enterprise wide initiatives.
- Provides Medicaid P&L, actuarial and enterprise financial support in the analysis of medical expenses, medical expense trend, membership, revenue, medical loss ratio and drill downs.
- Provides Medicaid Business Units and leaders with analysis of revenue and medical costs on a restated basis and reconcile restated financial results to results reported in financial statements in prior periods - to help strengthen performance management.
- Independently develops sound applications and models necessary to efficiently measure, understand, monitor and explain the company's medical cost structure and restated financial results.
- Measures and evaluates risks, models and forecasts future implications and recommends actions, consistent with established analytical methods and standards.
- Performs independent valuation of corporate medical expense performance metrics and valuation of management program initiatives
- Prepares comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses.
- Present medical cost trends to a wide audience on a regular basis
- Consults with our customers including P&L, Product Management, Underwriting, Provider Contracting, Clinical, Claims Processing and Finance on analyses and recommendations regarding appropriate courses of actions.
- Requires BS/BA degree in Mathematics, Statistics, Finance or Economics 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.
- Progressive data analysis and reporting experience.
- Proficiency with Microsoft Excel
- SQL experience.
- 3+ years of experience in managed healthcare analytics
- 3+ years of experience in Medicaid.
- Familiarity with claims data and authorization data experience
- Advanced Excel knowledge.
- PowerBI or Tableau
- Teradata experience.
- SAS experience.
- Master's degree.
Vacancy expired!