Partners Healthcare System Somerville , MA 02143
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 developmentand 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.
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 relations with Medicare, Medicaid and Commercial health insurance plans. Examples of such issues include, but are not limited to:
Hospital and physician reimbursement and financial performance
Payment reform and the introduction of new payment models like global risk and bundled payments
Management of medical cost trend
Quality performance, incentives and measurement
Accountable care organization progress and development
Reporting to the Senior Manager of Hospital Analytics, the Manager supports the negotiation, implementation and ongoing maintenance of Partners' contracts, primarily with respect to hospital reimbursement. The Manager will identify related issues that require a decision by leadership and will organize research and analyses sufficient to develop options and recommendations for consideration by the department and key decision makers within Partners.
The Manager is responsible for the development of materials used in the presentation of findings and recommendations to a wide range of constituents, including corporate level business leaders and leadership of the provider organizations. The Manager will be involved in direct negotiations as part of the negotiating team when his/her content expertise is needed and will collaborate with colleagues at the health plans and within Partners' hospitals to oversee implementation of related contract terms.
We seek a person with advanced analytic and strategic thinking capability, intellectual curiosity and an interest in mentoring and managing analytic staff. This position requires the ability to understand complex topics, particularly related to hospital reimbursement. Candidates must possess strong management and communication skills, and the ability to work as part of a team in a matrix environment.
Principal Duties and Responsibilities
1.Lead the development of detailed strategic analyses of hospital reimbursement, including assessment of changes to fee schedules and payment policy, the development of Partners' acute hospital pricing strategy and the evaluation of alternative payment arrangements, e.g., bundle payments.
2.Develop presentation materials to lay out the context of issues related to the above, including relevant facts and analysis and options, such that decision makers are well informed and able to make key decisions in critical areas. Facilitate discussions at various committees.
3.Participate in negotiating sessions with third party payers with respect to hospital reimbursement issues. Develop and review related contract language, in collaboration with Contracting and OGC colleagues.
4.Oversee implementation of contract provisions related to hospital reimbursement, working closely with colleagues at the hospitals, revenue cycle and revenue finance/budget.
5.Serve as a resource for questions from colleagues and constituents regarding hospital reimbursement and related issues; manage the process for responding to ad hoc requests in a timely manner.
6.In collaboration with the Senior Manager and Team Lead, ensure that the work of Hospital Analytics is staffed in a manner that reflects analysts' capacity, skills and interests. Develop, monitor and adjust workplans as needed.
7.Oversee professional development of analytic staff and contribute to the department's employee engagement efforts.
8.Maintain constructive, professional relations with third party payers in order to represent Partners effectively.
9.Maintain constructive, professional relations with key internal constituents, including PHS System Contracting Managers and OGC staff and hospital CFOs, Executive Directors and analytic staff.
10.Participate in department staff/related committee meetings.
1.Bachelor's degree is required (Masters preferable) in business, health care administration, finance, or related fields.
2.At least seven years of progressively responsible experience in a complex healthcare environment.
3.Strongly preferred that candidate has specific experience and strong track record in health care finance, ideally in the area of managed care and hospital reimbursement.
4.Prior management experience preferred.
5.Proficiency with Microsoft Office products, including Excel, Access, Word and PowerPoint; experience with SQL and Alteryx a plus
1.Substantial knowledge of the healthcare market; includes facts, concepts and trends that are general to the industry and specific to Partners and the work of the department. In particular, this position requires knowledge of terms and issues related to managed care and hospital reimbursement. Familiarity with hospital reimbursement/billing, and pricing strategy preferred.
2.Strong quantitative and analytic skills, with the ability to understand complex concepts and attention to detail. Must be able to oversee analysts who are using sophisticated software functionality, including but not limited to manipulation of large data sets, database management, querying and financial modeling ranging from Excel and SQL based models to more advanced forecasting and optimization models.
3.Interest in and the ability to teach and mentor others. Must maintain a focus on professional development of staff, team building and employee engagement.
4.Ability to think strategically and creatively; able to develop well-reasoned conclusions, test against relevant criteria/standards and assess in context of the environment and organizational priorities.
5.Excellent communication skills with the ability to break down and explain complex analytic issues and present findings and recommendations to various levels of management. Contract provisions are complex and require a strong written communication skills and attention to detail.
6.Highly organized with strong project managements skills; able to manage multiple projects and deadlines and delegate responsibility to others. 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, often 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.
Office environment (desk and telephone work) with some regional business travel (primarily by automobile).
Supervise three to four analytic staff directly and coordinate project work with the Senior Manager and Team Lead of Hospital Analytics as well as staff from the rest of Payer Strategy and Contracting, Partners' hospitals, plus legal staff and clinical and other content experts as needed.