Provider Contract/Cost of Care Analyst Senior

Description SHIFT: Day JobSCHEDULE: 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, gr 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.Provider Contract/Cost of Care Analyst Senior Norfolk, VA, Richmond, VA, Chicago, IL, St. Louis, MO, Atlanta, GA or Iselin, NJWe are looking for an experienced healthcare analyst to join our team of Health Economics experts. The Analyst will support to the Cost of Care and Provider Contracting organizations by building and analyzing data to tell a story. The ideal candidate is a broadly experienced professional who can find savings opportunities and key trends within claims data. The Provider Cost of Care Analyst must be self-directed and comfortable supporting the data needs of multiple teams and systems. The Provider Contract Cost of Care Analyst Senior 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 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 contract negotiations.
• Participates on project team involved with enterprise wide initiatives

• Requires a BS/BA degree in related field.
• 3-5 years data analysis or related experience.
• Any combination of education and experience, which would provide an equivalent background.
• 3+ years of SQL and/or SAS experience required.
• SAS experience strongly preferred.
• Intermediate Excel skills required - Ability to create pivot tables, complex graphs, use VLOOKUP and HLOOKUP, as well as nested IF statements and mathematical equations.
• Payment Innovation/Provider Collaboration.
• Identifying healthcare drivers and trends.
• Healthcare revenue and claims data experience.
• Experience with relational databases and knowledge of query tools and statistical software is required.
• Ability to manipulate large sets of data is also required.
• Strong analytical, organizational and problem solving skills.