HomeData Science Jobs- USAMass General Brigham(PHS) | Hiring | Managed Care Analyst II, Advanced, Payer...

Mass General Brigham(PHS) | Hiring | Managed Care Analyst II, Advanced, Payer Contracting (Remote or Hybrid) | Somerville, MA | BigDataKB.com | 5 Oct 2022

Job Location: Somerville, MA

Managed Care Analyst II, Advanced, Payer Contracting (Remote or Hybrid)

– (3199367)

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As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

General Overview

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 Managed Care Analyst II Advanced will support the Payer Contracting team by providing analyses related to the negotiation, implementation and ongoing maintenance of Mass General Brigham contracts. The Managed Care Analyst II Advanced 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, development of fee schedules and monitoring of key market statistics. The Managed Care Analyst II Advanced also presents findings and recommendations to a wide range of constituents, including corporate level business leaders and leadership of the provider organizations.

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 analytic support to a variety of project work such as the following…

  • Development and implementation of hospital and physician fee schedules
  • Evaluation of the impact on reimbursement of hospital outpatient bundling logic and/or other payment policy changes.
  • Assessment of alternative payment arrangements, including Mass General Brigham’s global risk agreements, bundled payments, etc.
  • Negotiation and maintenance of provider subcontracting arrangements
  • Assessment of payer contract margin performance for Mass General Brigham facilities, including analysis of key trend drivers
  • Production of inputs to Mass General Brigham’s annual budget and long-range forecasting processes
  • Setting charges for acute hospital services

2. Monitor and report on key market trends, using resources like Center for Healthcare Information and Analysis (CHIA) reports on relative prices and health care expenditures, State cost hearing reports, health plan enrollment trends and financial performance
3. Assist with documentation of final contract terms and related language, including specifics of hospital and physician reimbursement, risk and global budget terms and rate exhibits.
4. Development of presentation materials to lay out the context of issues under discussion, analytic findings, options, and recommendations, such that leadership is well informed and able to make decisions.
5. Maintain constructive, professional relations with third party payers and key internal constituents, effectively representing Mass General Brigham and the Payer Contracting team.
6. Participate in other Payer Contracting projects as needed


Qualifications

1. Bachelor’s degree is required (Masters preferable) in business, health care administration, finance or related fields.
2. Minimum of three years analytic and database experience required, preferably in a healthcare environment.
3. Preferably a working knowledge and understanding of hospital/physician reimbursement methodologies and/or health insurance underwriting for assessing risk terms and analytics.
4. Intermediate competency in use of Excel and Access relational databases, or comparable software products. Competency in Word and Power Point. Experience with business intelligence tools like Alteryx and Tableau is preferred

Skills, Abilities and Competencies Required

1. Intermediate 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. Requires the use of sophisticated software functionality including but not limited to manipulation of large data sets, database management, experience with querying language and financial modeling.

3. Strong communication skills, with the ability to break down and explain complex analytic issues and present findings and recommendations.

4. Excellent customer service skills; demonstrates an understanding of customers’ needs, provides accurate and reliable information to constituents and maintains professional relationships with key contacts.

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 project managements 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. Ability to work independently in a complex, sometimes fast-paced environment. A self-motivated and resourceful attitude, taking intellectual ownership of work and the projects. Proactive in identifying issues, prepared to address concerns/questions, and make recommendations.

#LI-Remote


EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.


Primary Location
MA-Somerville-MGB Assembly Row

Work Locations
MGB Assembly Row 399 Revolution Drive Somerville 02145

Job
Professional/Managerial

Organization
Mass General Brigham(PHS)

Schedule
Full-time

Standard Hours
40

Shift
Day Job

Employee Status
Regular

Recruiting Department
MGB Finance, Analytics & Planning

Job Posting
Aug 23, 2022




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