Anthem Inc. Virginia Jobs

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Anthem, Inc. Health Information Consultant Senior in Richmond, Virginia


SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Health Information Consultant Senior

The preferred locations for this position are California, Arizona, Nevada, Tennessee and Virginia

but other locations will be considered.

The Health Information Consultant Senior is 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. The Primary duties may include, but are not limited to:

  • 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.

  • Utilization of Tableau, PowerPivot, additional dashboard, reporting, and visualization applications.

    Through data interpretation and understanding of cost of care and economics, the Health Information Consultant Senior will assist in the development of the provider network through, but not limited to;

  • In and out-of-network utilization, geo-access reporting and provider contract proposal modeling.

  • This position will be key in evaluating and recommending provider contract rate structures and alternative payment models that are well defined and standardized.


Minimum Requirements

  • 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

    Preferred Skills, Capabilities and Experience

  • Excellent knowledge and understanding of data warehouse data structures and data flows is strongly preferred.

  • Excellent oral and written communication, analytical and planning skills and knowledge of standard Business Information tools and programming/query languages preferred.

  • Experience in managed care and data analysis is preferred.

  • Practical business experience is preferred.

  • Knowledge and understanding of data warehouse data structures and data flows and standard Business Information tools and programming/query languages.

  • Excellent communication skills.

  • Advanced Excel

  • SAS

  • Intermediate+ SQL Programming

  • Intermediate+ Tableau Development

  • Bonus for Python/VBA

  • Any certification tied to Tableau is a huge plus.

  • Industry Knowledge

  • Common healthcare financial metrics: Loss Ratios, Profit Margins

  • Common healthcare utilization metrics: PMPM, % Per K, LOS, Readmissions, etc.

  • Cost Drivers: Network, Cohort Acuity, Utilization, Prior Authorization, etc.

  • Spend Categories: Inpatient, Outpatient, Professional, Facility

  • Benefit Categories: Part A/B, Bundled/Episodic, Fee for Service, etc.

  • Actuarial Concepts: Completion/IBNR, Risk Scores, Credibility

  • Provider Drivers: RVUs, Incident to billing, Defensive Medici

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.

REQNUMBER: PS69903-Richmond-Richmond