Prov Contract/CofC Consult or Sr. Consult(3)-64812
WellPoint - South Portland, ME

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Prefer person located in either S. Portland, ME, Richmond, VA, Louisville, KY, or Woodland Hills, CA, but will consider any WLP location. Dependent on experience will hire either a Provider Contract/CofC Consultant or a Senior Consutlant. 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 expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works on 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. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. 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 to track both health risks and compliance, as well as supporting the contract negotiation process. Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex 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 pre-negotiation analysis 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; researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates; and projects 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. Recommends policy changes and claims 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. Acts as a source of direction, training and guidance for less experienced staff.

Job Qualifications

Requires BS/BA degree in Mathematics, Statistics, or related field; 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. Masters degree preferred. Healthcare experience is required, managed care is preferred. Requires strong SAS experience (7+ yrs) and experience with EDWard datawarehouse is preferred. Ancilliary provider reimbursement experience is a plus. Once an offer is accepted, all external applicants are subject to a background investigation and if appropriate, drug testing. Offers of employment shall be contingent upon passing both the background investigation and drug testing (if required).

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We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more...