Prov Contract/CofC Sr. Analyst or Consultant
Company Name:
UniCare Life & Health Insurance Company
Job Description
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 in WellPoint's 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.
Job Qualifications
Requires BS/BA degree or equivalent experience; suggested fields of study include Informatics, Mathematics, Public Health, Statistics, Business, Computer Science, or a related field. Masters 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. WellPoint clams systems and data warehouses knowledge (EDWard, local data warehouses) preferred. Medicare Advantage analytic experience preferred.
_WellPoint is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about the company, please visit us at . EOE.M/F/Disability/Veteran._
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).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.Estimated Salary: $20 to $28 per hour based on qualifications.
UniCare Life & Health Insurance Company
Job Description
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 in WellPoint's 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.
Job Qualifications
Requires BS/BA degree or equivalent experience; suggested fields of study include Informatics, Mathematics, Public Health, Statistics, Business, Computer Science, or a related field. Masters 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. WellPoint clams systems and data warehouses knowledge (EDWard, local data warehouses) preferred. Medicare Advantage analytic experience preferred.
_WellPoint is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about the company, please visit us at . EOE.M/F/Disability/Veteran._
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).
Current WellPoint associates: All referrals must be submitted through the formal associate referral process on WorkNet. Official guidelines for the associate referral program can be found in My HR.Estimated Salary: $20 to $28 per hour based on qualifications.
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