Provider Contract Cost of Care Analyst Sr or Consultant -job family (90105) Any Office Location

Company Name:
We are one of the nation's leading health benefits companies and a Fortune Top 50 company. We are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Our world class Healthcare Analytics (HCA) division analyzes data (with Microsoft Office tools such as Access and Excel, and SAS and/or SQL programming) and works with senior management and contract/account managers to "right price" commercial and Medicare Advantage provider reimbursement, improve the quality of care, maintain innovative and Federal Healthcare Reform-compliant reimbursement frameworks, and increase member and provider network satisfaction. HCA Analysts provide expert advice and analytic and consultative support to Network Management and Medical Directors in achieving financial Unit Cost targets. Supports large scale, complex projects/high dollar cost savings efforts as enterprise lead or as part of project team. Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process, with a focus on financial impact analyses and "what if" scenario/financial planning for potential provider contracting scenarios. Can work with multiple provider types, e.g. physician, ancillary, hospital, or medical groups. Supports a full range of contract arrangements and pricing mechanisms. Additional types of analyses include; performing sophisticated quarterly Unit Cost trend forecasts, building new and modifying existing complex models to create predictive impact decision making tools, and preparing pre-negotiation analytics to support development of defensible pricing strategies. Creates retrospective data analytics to ensure forecasted cost targets are met 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 data-intensive contract negotiations. Acts as a source of direction, training and guidance for less experienced staff.
Provider Contracting/Cost of Care Analyst Sr:
Requires BS/BA degree in Mathematics, Statistics, or 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. Master's degree preferred.
Provider Contracting/Cost of Care Consultant:
Requires BS/BA degree or equivalent experience; suggested fields of study include Informatics, Mathematics, Public Health, Statistics, Business, Computer Science, or a related field. Master's degree preferred. Experience with a Healthcare Insurance provider/company such as Health Benefits Company, Physician group or Hospital/Medical Center is preferred. Minimum of 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. Requires strong Microsoft Access, Excel skills. SAS or SQL experience preferred. Experience with ancillary provider claim reimbursement (Durable Medical Equipment, Ambulance, Homecare, etc.) is a plus. Anthem clams systems and data warehouses knowledge (EDWard, local data warehouses) preferred. Medicare Advantage analytic experience preferred.
Prefer person located in either New York, NY, Woodland Hills, CA, Atlanta, GA, Denver, CO, Las Vegas, NV, South Portland, ME, Manchester, NH, or Wallingford, CT, but will consider any WLP location.
Will hire either Provider Contracting/Cost of Care Analyst Sr or Provider Contracting/Cost of Care Consultant
/We are ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at/ / / /. EOE.M/F/Disability/Veteran./
Job Reporting & Data Analysis
Title: Provider Contract Cost of Care Analyst Sr or Consultant -job family (90105) Any Office Location
Location: AZ-Scottsdate
Other Locations: NH-Manchester, ME-South Portland, GA-Atlanta, NV-Las Vegas, CA-Woodland Hills, New York, CO-Denver, CT-Wallingford
Requisition ID: 90105

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