Finance Operations Lead, Payer Contracting
Job Location:
Somerville, NJ - USA
Monthly Salary:
Posted on:
Vacancies:
Job Summary
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 Payer Contracting group is responsible for the negotiation and management of contracts with health insurance plans and the evaluation of government payment policy on behalf of Mass General Brigham (formerly Partners HealthCare) providers. The Payer Contracting group evaluates key health policy healthcare payment and market issues that arise from or are addressed through the systems relationship with Medicare Medicaid and commercial health insurance plans. The department also works closely with Population Health Management Community Health Government Affairs Revenue Cycle Quality Safety and Value and other corporate financial functional areas. The departments scope of work includes:- Negotiation and implementation of commercial contracts
- Evaluation of government payment policy changes in support of advocacy efforts
- Development and implementation of payer strategy
- Revenue projection for annual budget and multiyear capital framework
- Evaluation of alternative payment models including accountable care organizations bundles and pay for-performance quality incentive programs
Qualifications
Bachelors degree in Finance Accounting Healthcare Policy/Management Healthcare Administration or a related field
Masters Degree in a related field preferred
5 years of healthcare financial analysis budgeting or financial management experience required
Experience in managed care or hospital reimbursement working with payor and complex reimbursement methodologies including transplant pricing/modeling drug pricing/trends and involving the following: (1) creating standards for analytic approach; (2) writing standardized analytic plans/workflows applicable across departmental projects; (3) using advanced SQL and Access.
3 years using Alteryx for advanced data analytics and Microsoft Office suite particularly Excel Word and PowerPoint
2 years leading projects that influence the strategic direction and decision making of an organization and training mentoring and developing staff members.
A skills assessment may be required as part of the interview process focused on advanced SQL and Access which will include accessing a data source and a separate case study assessment intended to measure subject matter/content knowledge.
Duties and Responsibilities:
Serving as team lead the incumbent will be responsible for optimizing data and analytic processes to improve timeliness and quality as part of thePayer Contracting group which is responsible for providing data analyses in support of the negotiation implementation and management of Mass General Brigham contracts with health insurance plans and hospital reimbursement as well as evaluating key health policy healthcare payment and market issues that arise from or are addressed through Mass General Brigham relations with Medicare Medicaid and Commercial health insurance plans.
Identify related issues that require a decision by leadership and organize research and analyses sufficient to develop options and recommendations for consideration by the department and key decision makers within Mass General Brigham.
Develop presentation materials laying out the context of issues including relevant facts and analyses and options to a wide range of constituents including corporate level business leaders and leadership of the provider organizations to enable well-informed key decision making in critical areas as well as facilitate discussions at various meetings and committees.
Develop detailed strategic analyses of value-based care models including commercial and government risk and quality arrangements. Evaluate hospital and physician reimbursement including assessment of changes to fee schedules and payment policies the development of Mass General Brigham acute hospital pricing strategy alternative payment arrangements (e.g. risk quality bundled payments) and evaluating the impact of Medicare changes on commercial insurer rates.
Participate in negotiation sessions as necessary with third party payers with respect to hospital and physician reimbursement issues.
Develop and review related contract language in collaboration with Contracting and Office of General Counsel (OGC) colleagues and lead time-sensitive valuation of complex negotiation proposals.
Maintain constructive professional relations with third party payers in order to represent Mass General Brigham effectively.
Oversee implementation of contract provisions related to value-based care arrangements working closely with clinical and financial colleagues within Population Health Management at the hospitals and physician organizations revenue cycle and revenue finance/budget.
Serve as a resource for questions from colleagues and constituents regarding value-based care arrangements and related issues; manage ad hoc requests in a timely manner.
Review junior staff members analytic output prior to managers review.
In collaboration with the Manager ensure that the work of Contract Finance is staffed in a manner that reflects analysts capacity skills and interests as well as develop monitor and adjust workplans as needed.
Mentor and oversee professional development of analytic staff and contribute to the departments employee engagement efforts.
Participate in and/or facilitate department staff/related committee meetings.
Train and advise junior staff members on applications (e.g. SQL Alteryx Tableau) complex modeling of value-based care methodologies and valuations as well as create analytic resources for team to leverage.
Conduct data analytics including database querying data validation and interpretation complex financial modeling and scenario building as well as provide business insights to help build the forecasting model. Build contract terms into workflow to model the reimbursement rates.
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$99465.60 - $144643.20/AnnualGrade
8EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
