Finance Operations Lead, Payer Contracting

Role Description

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 department’s 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

Serving as team lead, the incumbent will be responsible for optimizing data and analytic processes to improve timeliness and quality, as part of the Payer 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 manager’s 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 department’s 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.

Qualifications

• Bachelor’s degree in Finance, Accounting, Healthcare Policy/Management, Healthcare Administration or a related field
• Master's 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.

Requirements

• Remote Type: Remote
• Work Location: 399 Revolution Drive
• Scheduled Weekly Hours: 40
• Employee Type: Regular
• Work Shift: Day (United States of America)
• Pay Range: $99,465.60 - $144,643.20/Annual
• Grade: 8

Benefits

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. In 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.