AnaheimRecruiter Since 2001
the smart solution for Anaheim jobs

Prov Contract/CofC Consult Sr.

Company: Anthem, Inc
Location: Anaheim
Posted on: March 23, 2020

Job Description:

Prov Contract/CofC Consult Sr. - PS32816Location: United StatesNewRequisition #: PS32816Post Date: 5 days agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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 benefits companies and a Fortune Top 50 Company.

  • Provides the highest level of 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 to Medical Directors and management on cost of care issues.
  • Leads large scale initiatives with high dollar cost savings opportunities.
  • Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process.
  • Works with multiple provider types including the most complex, high profile providers.
  • Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms.
  • Works on the most complex, large scale enterprise wide initiatives and acts as project lead.
  • Acts as a strategic partner to management.Primary duties may include, but are not limited to:
    • Uses analytic tools to: track both health risks and compliance, as well as supporting the contract negotiation process.Types of analyses include:
      • Performing sophisticated retrospective data analytics;
      • Developing the most complex new models and modifies existing models to create predictive impact decision making tools;
      • Performing 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 complex 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'; measuring and evaluating the cost impact of various negotiation;
      • Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates;
      • Projects different cost of savings targets based upon various analytics.(Primary duties continued...)
        • 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.
        • Researches providers financial profitability/stability and competitive environment to determine impact of proposed rates.
        • Communicates fee strategies to manage provider expectations.
        • Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
        • Educates provider contractors on contracting analytics from a financial impact perspective.
        • May recommend alternative contract language.
        • May go on-site to provider premises during contract negotiations.
        • Acts as a source of direction, training and guidance for less experienced staff. Looks for continuous quality improvements and finds better ways to accomplish end results.
        • Works side by side with their manager.Requires BA/BS degree in Mathematics, Statistics or related field; 7+ years experience in broad-based analytical, managed care payor or provider environment; in depth experience in statistical analysis and modeling; or any combination of education and experience, which would provide an equivalent background. Experience providing leadership in evaluating and analyzing complex initiatives required. Master's degree preferred.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Anaheim , Prov Contract/CofC Consult Sr., Other , Anaheim, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


STRAIGHT TRUCK INDEPENDENT CONTRACTORS
Description: STRAIGHT TRUCK INDEPENDENT CONTRACTORS Updike DL is looking for independent contractors that are experienced in home delivery and assembly of furniture and household items in San Diego area. We have an (more...)
Company: Updike Distribution Logistics
Location: National City
Posted on: 04/2/2020

The Home Depot Rental – CDLA Delivery Service Technician (Pico Rivera, CA)
Description: Class A CDL Required - This position requires a CDLA Driver with endorsements for Air Brakes, familiarity with Cargo Securement, and experience driving Class 8 and Heavy-Duty trucks Must be at least (more...)
Company: Home Depot
Location: Pico Rivera
Posted on: 04/2/2020

Deliver with Uber Eats this spring
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you.Earn Extra Money. You ll earn (more...)
Company: Uber Eats
Location: National City
Posted on: 04/2/2020


Modeling Actuary
Description: Pacific Life is looking to invest in bright, agile new talent to ensure we continue to innovate and strengthen relationships with our policyholders. It s in this spirit that we are currently looking (more...)
Company: Pacific Life
Location: Aliso Viejo
Posted on: 04/2/2020

Deliver with Uber on your schedule
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you.Earn Extra Money. You ll earn (more...)
Company: Uber Eats
Location: Encinitas
Posted on: 04/2/2020

Premier Banker 2 - Friars Mission Center
Description: Job Description br Important Note: During the application process, ensure your contact information email and phone number is up to date and upload your current resume when submitting your application (more...)
Company: Wells Fargo Bank
Location: National City
Posted on: 04/2/2020

Online and Digital Product Leader
Description: In this role you will: Define and track metrics to measure product KPIs and success metrics. Drive a strong product roadmap that meets customer requirements and offers value to our customers. Proactively (more...)
Company: Constellation1
Location: Aliso Viejo
Posted on: 04/2/2020

Premier Banker 2 - Friars Mission Center
Description: Job DescriptionImportant Note: During the application process, ensure your contact information email and phone number is up to date and upload your current resume when submitting your application for (more...)
Company: Wells Fargo Bank
Location: National City
Posted on: 04/2/2020

Deliver Food with Uber Eats
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you.Earn Extra Money. You ll earn (more...)
Company: Uber Eats
Location: La Mesa
Posted on: 04/2/2020

Analytical Chemist
Description: Awesome Direct hire opportunity with a well stablished Pharmaceutical Company Looking for an Analytical Chemist to join our amaizing team Analytical Chemist Function: Perform analytical testing in accordance (more...)
Company: Eastridge Workforce Solutions
Location: Lynwood
Posted on: 04/2/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Anaheim RSS job feeds