Health Information Consult Sr

Anthem, Inc. Nashville , TN 37201

Posted 2 months ago

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it's a powerful combination. It's 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.

CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America's largest managed healthcare organizations.

Responsible for identifying opportunities to improve health care affordability through analysis of data and transforming business intelligence into action plans. Provides strategic recommendations for improving health care affordability to executives and professional clients.

Primary duties may include, but are not limited to:

  • Devise, analyze, and enhance pro forma models, reports, and analysis, including Specialty, PCP and ancillary utilization and cost trend and pattern analysis, Part D pharmacy expense and utilization, clinic/clinician productivity, Acute and SNF inpatient (MS DRG Case Mix Index analysis, days and admits per thousand, ALOS, readmit calculations, etc.), HCC Risk Adjustment, etc.

  • Provide unit cost vs. utilization impact analyses to guide key decisions and protect CareMore profitability.

  • Perform research on unanticipated network cost, provider, or member issues, such as provider terminations, disenrollment, or run-rate cost increases.

  • Serve as a subject matter expert for medical economics, including Medicare equivalency analysis and unit economics.

  • Apply statistical concepts such as standard deviation, geometric mean, quartiles/deciles stratification of cost vs. acuity, bell curves/outlier evaluation, correlation coefficients, population size credibility, predictive R2, etc.

  • Bring analytic insights alive via creative, intuitive visualizations in Tableau, including summary cost/utilization metrics with drill in detail to patient/claim level information.

  • Collaborates with the data warehouse analysts in establishing business rules and monitoring adherence.

  • Provides business expertise regarding the appropriate use of data elements and cooperates with reporting personnel from other areas to establish and maintain these common business rules.

  • Translates data trends into strategic recommendations for program development and action plans.

  • Tracks and prioritizes projects through coordination and negotiation with internal and external clients to improve the efficiency of information/project plan generation.

  • Evaluates and triages potential projects and studies based on the value, cost benefit analysis and the urgency of the request.

  • Performs strategic data analysis (data mining) and research as appropriate to support business needs (e.g., disease management, provider profiling, etc.).

  • Develops detailed understanding of relevant business processes, goals and strategy in order to provide analysis and interpretation.

  • Develops and communicates action plans to address areas for improvement identified through data analysis and business expertise.

  • Assists in planning initiatives to address areas for improvement.

  • Collaborates with business user to define media, frequency and audience for distribution of information.

  • Mentors (formally and informally) less experienced associates and identifies training needs and initiates education to address skill and knowledge gaps.

Qualifications

Requires a BS/BA degree; at least five years related experience in analysis and reporting; or any combination of education and experience, which would provide an equivalent background. Excellent knowledge and understanding of data warehouse data structures and data flows is required. Excellent oral and written communication, analytical and planning skills required. Knowledge of standard Business Information tools (Tableau, Excel Power Query) and programming/query languages (SQL) preferred. Experience in managed care and data analysis is preferred. Practical business experience is preferred. This job focuses more on higher level customers and developing action plans as compared to the Health Information Consultant job.

AnEqualOpportunityEmployer/Disability/Veteran

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.

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Health Information Consult Sr

Anthem, Inc.