Executive Director, Payer Contracting and Performance
Dana-Farber Cancer Institute
Location: Boston, Massachusetts
Internal Number: 2023-32398
The Executive Director reports directly to the Executive Vice President, Chief Finance and Business Strategy Officer and is accountable for providing strategic leadership regarding all aspects of health plan relationships, contracting, and health plan performance that support the mission and goals of Dana-Farber Cancer Institute. The position will oversee all payer contracting activities through strategies that ensure optimal financial and operational outcomes and will represent and advocate for the hospital and affiliated physicians as issues, opportunities, and disputes arise. The Executive Director is responsible for guiding and supporting DFCI efforts to prepare for the short- and long-term impact of health reform, payer strategy, clinically integrated networks, and response to ACOs that align with overall Institute goals. They will manage a significant portfolio of general medical and specialty contracts that apply to multiple hospital-licensed sites and over (250) affiliated physicians.
The Executive Director is responsible for negotiating and securing most favorable contract details that minimize the administrative burden of the revenue cycle and revenue support to the Institute through the negotiation of rates and performance targets tied to the agreements. Success from the individual in this role helps provide for the organizations continued growth and network expansion goals by providing essential health plan reimbursement revenue.
Given the challenges of being a comprehensive cancer center with a singular disease focus and the many co-dependencies with other health care providers, the role will be responsible for navigating a variety of political, business, legal and operations issues that this complex infrastructure presents. ??
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
Develop, negotiate, and manage a portfolio of payer contracts including commercial, managed Medicaid and Medicare products, and national center of excellence agreements that optimize organizational revenue, margin and growth in alignment with DFCI???s mission and strategic objectives.
Develop processes and manage implementation and ongoing management of completed agreements, including the identification and tracking of critical contractual obligations, renewal dates, and ensuring the appropriate recording and fling of documents occur.
Oversee payment policies and other relevant market intelligence.
Oversee payer relationships with a focus on promoting proactive, professional, and collaborative relationships, problem resolution, and avoidance of future issues.
Promote the use of Harvest, Strata, and other contract management tools to support negotiations, revenue recovery, and contract performance.
Work collaboratively with all relevant DFCI stakeholders (revenue cycle and other clinical/operational groups) to navigate health plan requirements.
Prepare and provide Institute training materials, payer and rate grids and other tools.
Oversee the execution of individual case negotiations LOAs and financial settlements as needed.
Manage the programs of distinction for oncology and hematopoietic stem cell transplant (COE), CarT, national payer/employer opportunities, and associated contracting efforts.
Population Health Management /Value????????????????????????????
Oversee team of data experts to consider regulatory developments and provide advanced analytics and strategic insights for health plan agreements, ACOs, APM, and network partnerships.
Together with senior clinical and quality leaders, facilitate all aspects of health plan partnership and pay-for-performance (P4P) arrangements and projects.
Comprehensive evaluation and cost/ benefit for deploying projects using ???big data???, (Medicare and MA all claims payer database) and other tools to study oncology attribution and population health models.
Analytical support to DFCI growth strategy with high-impact institutional reporting, dashboards and oncology trends, analysis, and pricing.
Establish payment models (traditional and alternative) to support the growth of strategic programs including community expansion, transplant, and immune effector cell therapy, and new to market oncology drugs and technologies.
Departmental alignment and Institutional support
Directly supervise a team of managers, analysts and support staff and leverages a complimentary team of critical expertise from other departments such as pharmacy, medical staff office, finance planning, budget and reimbursement, and revenue cycle.
Support a variety of leadership and multidisciplinary committees on special projects and business initiatives such as DFCI Pathways, new technology (pharmacy), DFCI business solutions, government and legislative responses, and BMT shared care.
Member representative to National Comprehensive Cancer Network (NCCN), Products and Services Committee.
Provide analytical and content expertise to support work of Alliance of Dedicated Cancer Centers (ADCC) value committee.
Support DFCI specialty pharmacy PBM contract strategy and deployment.
Lead the evaluation and analysis of new payment methodologies and value-based approaches to care that are identified through government (CMS, CMMI, MA HPC), health systems, ACOs, and others.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
Deep understanding of managed care principles and health plan products designs, payment models, and how to navigate a highly complex matrixed organization.
Project management skills and the ability to resolve complex problems and issues.
Analytical and problem-solving skills; excellent verbal and written communication and presentation skills.
Ability to work effectively as a team leader and cope successfully in a high-pressure environment.
Ability to have a steady, level-headed, confident, and optimistic approach to the work.
Ability to build and maintain strong business relationships with internal and external customers.
Strong negotiation skills including the ability to influence those over whom she/he has no formal authority.
Ability to delegate, trust, and rely on staff to handle projects in a timely and capable manner.
Proven leader with ability to motivate in a team-oriented, collaborative environment.
MINIMUM JOB QUALIFICATIONS:
Master???s degree in healthcare, accounting, finance, management, or related field of study required (e.g., MPH, MBA, JD). Clinical background highly desirable.
10 years of healthcare financial/managed care supervisory experience required.
Demonstrated track record of success in a similar role within complex health system, ideally one that manages payer and reimbursement analytics, and managed care contract negotiations for both the hospital and physicians
Competence in alternative payments models and their application in oncology care
Demonstrated competence in building and leading effective and cohesive tea
Demonstrated success in building and maintaining positive and effective relations between physicians, hospital leadership, and other key stakeholder
Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong.?? As relentless as we are in our mission to reduce the burden of cancer for all, we are equally committed to diversifying our faculty and staff.?? Cancer knows no boundaries and when it comes to hiring the most dedicated and diverse professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply.
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to under-served members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.