Who We ArePoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here (https://youtu.be/S5IHgoecJQ) .Job SummaryWorking with the Director, Network & Provider Analytics and other members of the Network & Provider Analytics team, the Senior Manager will lead the analytic support of contract negotiations, strategic initiatives and regulatory requests. This individual will manage staff as well as provide training and mentoring to all members of the team. The Senior Manager will directly support complex analysis related to negotiations and provider contracts and may actively participate in external provider meetings with Contract Managers. The individual will also provide support for regulatory requests around access and network adequacy.Key Responsibilities/Duties – what you will be doing
Manages analysts in design and execution of complex analyses to measure the financial impact of provider contracts and payment changes.
Maintains broad, comprehensive knowledge and understanding of provider contractual arrangements including value based reimbursement mechanisms and key cost and utilization performance drivers.
Proactively leads team to identify opportunities to improve Point32Health’s financial position through enhanced payment arrangements.
Manages the development and enhancement of department tools to aid in standard department work. Works with analytic staff to evaluate and recommend new and innovative financial models and processes.
Actively participates in external provider meetings with Network Contracting staff as needed
Oversees analytics around network access and adequacy across all lines of business in accordance with compliance and regulatory requirements. Additionally, will lead analysts in measuring the impact of contracts on network adequacy and access.
Recruit, train, develop, and evaluates staff performance. Manages the workload of team, meeting both high quality standards and customer timelines.
Other duties and projects as needed.
Qualifications – what you need to perform the job
Bachelor’s degree required; master’s degree in business administration, health policy, health economics, health services research, management science, medical sociology, or related field preferred.
7-10 years of experience with 3 years of effective supervisory experience.
Must have proven ability to achieve goals and to deliver bottom line results.
Advanced Excel skills; SAS/SQL programming required.
In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment.
Knowledge of Medicare and Medicaid reimbursement is a plus
Must have the ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into health care industry with an emphasis on managed care and finance related issues.
Possess strong analytic and technical skills and the ability to translate complicated data into useable information
Ability to manage multiple projects through others meeting customers’ timelines.
Excellent verbal and written communication skills; outstanding interpersonal skills;
Knowledge of network adequacy would be beneficial
Creative, flexible and self-motivated with excellent judgment.
Compensation & Total Rewards OverviewAs part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health EquityPoint32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.