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GENERAL SUMMARY/OVERVIEW STATEMENT:
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 system’s 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 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
The Senior Analyst will support the Payer Contracting team by providing analyses related to the negotiation, implementation and ongoing maintenance of Mass General Brigham contracts. The Senior Analyst is involved in a variety of projects, which may include research and analysis of issues related to hospital and physician fee-for-service reimbursement as well as alternative payment arrangements, price transparency, provider subcontract arrangements, fee schedule development and monitoring of key market statistics. The Senior Analyst also presents findings and recommendations to a wide range of constituents, including corporate and provider organization business leaders.
We seek a person with strong analytic capability, intellectual curiosity and an interest in being part of the evolution of healthcare provider reimbursement. This role requires: the ability to understand complex concepts, attention to detail, strong technical skills and the ability to work as part of a team in a matrix environment.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Provide senior level analytic support to a variety of projects such as:
· Commercial contract negotiations, including valuation assessments, complex financial modeling of contractual variables, and assessment of contractual language and reimbursement terms
· Development, implementation and communication of hospital and physician contractual terms
· Assessment and recommendation of pricing for acute hospital services, including hospital billed charges and service line pricing
· Negotiation and implementation of referring provider subcontracting arrangements
· Assessment of payer contract margin performance for Mass General Brigham facilities, including analysis of key trend drivers
· Assessment of alternative payment arrangements, including bundled payments, specialty drug pricing, new technology and services, etc.
· Evaluation of the impact on reimbursement of hospital outpatient bundling logic and/or other payment policy changes.
· Production of inputs to Mass General Brigham annual budget and long-range forecasting processes
2. Monitor and report on key market trends, using resources like Center for Healthcare Information and Analysis (CHIA) reports on relative prices, health care expenditures, state cost hearing reports, health plan enrollment trends and financial performance
3. Develop presentation materials laying out the context of issues under discussion, analytic findings, options, and recommendations, to inform leadership decision making
4. Key contributor to documentation of final contract terms and language related to provider issues and related financial exhibits, in collaboration with Contracting and Office of General Counsel (OGC) colleagues
5. Contribute to or lead other Payer Strategy and Contracting projects as needed, ranging from organizational strategy to department-wide initiatives such as process improvement
1. Bachelor’s degree is required (Master’s preferable) in business, health care administration, finance or related fields
2. Minimum of four years analytic and database experience, preferably in a healthcare environment. Minimum of two years experience with relevant Master’s degree.
3. Working knowledge and understanding of hospital/physician reimbursement methodologies and/or health insurance underwriting is preferred
4. Proficient use of Excel and Access or comparable software products, SQL, SAS, Alteryx, Tableau. Competency in Word and PowerPoint.
1. Understanding of the healthcare market as context for analytic responsibilities; includes facts, concepts and trends that are general to the industry and specific to Mass General Brigham and the work of the team.
2. Strong quantitative and analytic skills, with the ability to understand complex concepts and attention to detail.
3. Requires advanced technical skills and use of sophisticated software functionality including but not limited to manipulation of large data sets, database management, experience with querying language and financial modeling.
4. Strong communication skills, with the ability to turn data into actionable information in an accurate, reliable and timely manner and present findings and recommendations.
5. Ability to think strategically and critically, to develop well-reasoned conclusions, test against relevant criteria/standards and assess in context of the environment and organizational priorities
6. Organized with solid project management skills; able to manage multiple concurrent projects and deadlines. Effectively use various tools to initiate a project, monitor progress, anticipate obstacles and provide concise updates in a timely manner.
7. Excellent customer service skills; demonstrates an understanding of customers’ needs, provides accurate and reliable information to constituents and maintains professional relationships with key contacts.
8. Ability to work independently in a complex and often fast-paced environment. A self-motivated and resourceful attitude, taking intellectual ownership of work and projects. Proactively identifying issues, prepared to address concerns/questions and make recommendations.
Office environment (desk and telephone work) with some regional business travel (primarily by automobile). Minimal lifting.