Senior Financial Analyst

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The Senior Financial Analyst provides value-added analytic support to Provider Network Management (PNM) in meeting Mass General Brigham Health Plans strategic objectives. S/he must have extensive experience working with Medicare and/or Dual Eligible Special Needs Plans claims data. S/he possesses in-depth knowledge of contracting and risk-sharing models and regulatory issues governing payments to providers in a Medicare Advantage and/or Dual Eligible Special Needs Plans setting. S/he independently designs and performs analyses to measure the financial impact of provider contracts and reimbursement addition s/he effectively partners with Finance and PNM staff and managers in support of specific contract negotiations as well as broader network-wide payment models.

ESSENTIAL FUNCTIONS

• Works collaboratively with PNM staff and managers in support of contract negotiation and other provider payment changes:
  • Functions as the subject matter expert regarding Medicare reimbursement methodologies
  • Researches guidelines requirements and changes to Medicare reimbursement methodologies
  • Gathers and analyzes information from multiple sources to develop a profile of provider/facility facilitating a more robust contracting conversation
  • Identifies opportunities for improved savings and payment models to better align provider incentives
  • Translates business objectives into data queries and analytic models
  • Actively participates in strategy discussions with PNM and finance colleagues in discussions regarding the overall direction and objectives for specific contracts
  • Effectively interprets data and communicates findings/recommendations both orally and in writing appropriate to the audience
  • Actively participates in external provider contract meetings with PNM colleagues
• Designs and executes complex data queries and analyses to evaluate the impact of proposed and actual contractual changes
• Models various scenarios to assist PNM staff in understanding options in contracting models
• Develops ongoing means to monitor the financial/cost impact of new and existing contracts and other payment changes including global payment and risk-sharing arrangements

• Proactively identifies opportunities to improve Mass General Brigham Health Plans financial position through enhanced payment arrangements
• Work collaboratively with the Actuarial Team in support of ongoing Trend Analysis.
  • Design and execute queries to identify drivers of change in unit cost
  • Analyze data and quantify impact of unit cost on overall medical cost trend by category of care and by product/line of business
• Designs and executes queries and develops reports in support of state and federal regulatory requirements
• Collaborates with finance and budget staff in quantifying the impact of contract savings on overall medical expenses and trends
• Ensures the validity and accuracy of all data/information reported and presented
• Works collaboratively with IT to: enhance automation of processes; establish data warehouse standards and definitions; and to identify new tools to facilitate standard querying and reporting

• Anticipates and meets or exceeds internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Hold self and others accountable to meet commitments
• Ensure diversity equity and inclusion are integrated as a guiding principle
• Persist in accomplishing objectives despite obstacles and setbacks to consistently achieve results
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization

Qualifications

• Bachelors degree required; Masters degree preferred
• At least 3-5 years of experience in accounting or finance required
• Prior experience working for a health plan or in a managed care setting preferred
• At least 4-6 years of Medicare and/or Dual Eligible Special Needs Plans analytic IT reimbursement and/or contract configuration experience in healthcare highly preferred
• At least 2-3 years prior experience working with Medicare Advantage and/or Dual Eligible Special Needs Plans claims data highly preferred

Knowledge Skills and Experience:

• Possess strong analytic and technical skills and the ability to translate complicated data into useable information
• Experience with working in Medicare audits
• In-depth knowledge and understanding of health care claims data coding schemes (e.g. ICD CPT) grouping methodologies (e.g. DRG EAPG) and risk adjustment
• Demonstrated knowledge of managed care concepts and the financial relationship between payors and providers
• In-depth knowledge and understanding of the various payment methodologies and types of contractual relationships payors have with providers including global and bundled payments and risk-sharing arrangements
• Demonstrated knowledge of database and data structures as well as of general systems technology
• Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously
• Ability to conduct analytic work in an efficient manner with minimal re-work including effective use of the peer review process
• Familiarity with generating Medicare and state mandated regulatory filings
• Adept at documenting work and creating instructional guides
• Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally at Mass General Brigham Health Plan and externally with providers
• Creative flexible and self-motivated with sound judgment
• Exercises self-awareness; monitors impact on others
• Receptive to and seeks out feedback; uses self-discipline to adjust to feedback
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening challenging conventions and providing value.
• Respect the talent and unique contribution of every individual and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

Working Conditions

• This is a remote role that can be done from most US states

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$78000.00 - $113453.60/Annual

Grade

7

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework