Anthem, Inc. Dir Provider Economics in St. Louis, Missouri
SHIFT: Day Job
Your 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.
Prefer this person be located in Chicago, IL or Denver, CO but will consider other Anthem locations. This role is not remote.
The Director Provider Economics directs the development, maintenance and measurement of provider networks both from an internal and external perspective, and provides expert advice and analytic support to local and national Provider Solutions.
Performs complex valuations of alternative network designs to determine optimal provider selection and forecasted performance of that network relative to targeted cost, quality and access goals.
Creates network dashboards to monitor the performance of provider networks.
Provides insights into new network design and existing network refresh strategies
Develops Competitive Intelligence solutions to evaluate Anthem’s reimbursement levels relative to other carriers at a market, network and provider level.
Consults with local markets on the effective use of competitive intelligence data to support optimal contracting outcomes.Primary
duties may include, but not limited to:
Prepares healthcare cost analysis to identify new, innovative strategies to control costs.
Performs complex fee modeling exercises.
Communicates fee strategies both internally and externally to manage provider expectations.
Prepares negotiation prep analysis to support development of negotiation strategy.
Evaluates cost impact of various negotiation proposals.
Provides analytic support during complex provider negotiations.
Provides day to day negotiation support for national ancillary providers (lab, dialysis, etc).
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
BA/BS degree in Business or related field.
5+ years experience in broad-based analytical, managed care payor or provider environment.
Experience in statistical analysis; or any combination of education and experience, which would provide an equivalent background.
CPA or MBA preferred.
Experience leading teams in a managed care payor or provider environment preferred.
In-depth knowledge of evaluating provider network performance from a cost and quality standpoint preferred.
In-depth knowledge of provider profiling methodologies to evaluate cost and quality (i.e. case-mix adjusted cost per service, ETG, DxCG) preferred
In-depth knowledge of Medicare and Medicaid reimbursement methodologies preferred.
Experience with Microsoft Excel, SAS, SQL and Tableau preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.