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Managed Care Analyst II
MGH Institute of Health Professions
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Managed Care Analyst II
MGH Institute of Health Professions
| About Us As a not-for-profit organization, Partners HealthCare 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, Partners HealthCare 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. Partners HealthCare 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 Partners HealthCare 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 Strategy and 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 Partners HealthCare System, Inc. (Partners) providers. The Payer Strategy and Contracting group evaluates key health policy, healthcare payment and market issues that arise from or are addressed through Partners relationship with Medicare, Medicaid and Commercial health insurance plans. The department also works closely with Population Health Management, Community Health, Government Affairs, Revenue Cycle and other corporate financial functional areas, and Quality, Safety and Value. 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 program The Financial Analyst II will support the Payer Strategy and Contracting team by providing analyses related to the negotiation, implementation and ongoing maintenance of Partners' contracts. The Financial Analyst II is involved in a variety of project work, 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 Financial Analyst II also contributes to the presentation of 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 position 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 Partners' global risk agreements, bundled payments, etc. • Negotiation and maintenance of provider subcontracting arrangements • Assessment of payer line margin performance for Partners' facilities, including analysis of key trend drivers • Production of inputs to Partners' annual and multi-year budgeting processes • Setting charges for acute hospital services 2. Monitor publication of and report on key market trends, e.g., CHIA reports on relative prices and health care expenditures, State cost hearing reports, health plan membership 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. Assist with the 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 both with third party payers in order to effectively represent Partners and with key internal constituents. 6. Participate in other Payer Strategy and Contracting projects as needed. Qualifications Qualifications 1. Bachelor's degree is required (Masters preferable) in business, health care administration, finance or related fields. 2. Minimum of two 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. Basic competency in Word and Power Point. Skills/Abilities/Competencies 1. Basic understanding of the healthcare market as context for analytic responsibilities; includes facts, concepts and trends that are general to the industry and specific to Partners and the work of the department. 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. Developing ability to think strategically and critically; able to develop well-reasoned conclusions, test against relevant criteria/standards and assess in context of the environment and organizational priorities. 6. Organized with basic project managements skills; able to manage multiple 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 one's work and the projects under one's scope of responsibility. Proactive in identifying issues, prepared to address concerns/questions, makes recommendations. EEO Statement Partners HealthCare 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. Partners Healthcare System Inc. is acting as an Employment Agency in relation to this vacancy.
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Internal Number: 3137643-1435_1607615250
About MGH Institute of Health Professions
MGH Institute of Health Professions, founded by Massachusetts General Hospital in 1977, is an innovative and independent graduate school in Boston that is a member of Partners HealthCare. A progressive leader in developing comprehensive models of health care education, the MGH Institute prepares advanced practice professionals in the fields of nursing, physical therapy, occupational therapy and communication sciences and disorders through a distinctive combination of academic study, clinical practice, and research. More than 1,200 students are enrolled in graduate level and certificate programs, with an increasing number of courses available online. The Institute is accredited by the New England Association of Schools and Colleges (NEASC).
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