Senior Manager, Provider Settlement

Bluecross And Blueshield Of Massachusetts Boston , MA 02298

Posted 2 months ago

Ready to help us transform healthcare? Bring your true colors to blue.

This position is responsible for managing the timely, consistent and accurate settlement of all BCBSMA provider risk sharing, capitation, and physician incentive contracts, including global payment models (e.g., AQC). Leading a team of four settlement analysts, the Director ensures adherence to the financial and legal terms of provider risk contracts, maintains compliance with all internal and external audit requirements, and effectively communicates quarterly settlement and incentive results with appropriate stakeholders. This position is a member of cross-functional workgroups focused on implementing BCBSMA's evolving provider risk arrangements and will also occasionally represent BCBSMA externally in response to provider questions pertaining to their settlements.

This position is responsible for managing the timely, consistent and accurate settlement of all BCBSMA provider risk sharing, capitation, and physician incentive contracts, including global payment models (e.g., AQC). Leading a team of four settlement analysts, the Director ensures adherence to the financial and legal terms of provider risk contracts, maintains compliance with all internal and external audit requirements, and effectively communicates quarterly settlement and incentive results with appropriate stakeholders. This position is a member of cross-functional workgroups focused on implementing BCBSMA's evolving provider risk arrangements and will also occasionally represent BCBSMA externally in response to provider questions pertaining to their settlements.

Key Accountabilities:

  • Manage the process of quantifying, assessing and tracking contract financial performance through intake of data, maintenance of settlement models, aggregation of results and ad hoc analysis.

  • Ownership of the reporting, financial schedules, and summaries that support BCBSA accounting, billing, financial planning, and rating processes.

  • Communicate settlement results at both the contract and network level.

  • Oversee the disbursement or collection of funds due under contract terms.

  • Work collaboratively with various functional areas throughout the company to support the implementation of current and evolving provider reimbursement strategies.

  • Serve as a liaison/subject matter expert to cross functional business partners at all levels throughout the organization, as well as externally to providers.

  • Continuously evaluate and identify opportunities for process improvement to mitigate financial exposure.

Leadership Responsibilities:

  • Challenge and motivate staff to complete their work with the highest standards of accuracy, while meeting internal quarterly cycle timelines and adhering to contractual deadlines for external deliverables.

  • Foster the continuous professional development and career growth of a diverse workforce; coach and mentor future leaders to build bench strength; identify and champion high potential talent.

  • Participate in the performance/compensation planning process ensuring that all associates have meaningful development plans and performance reviews. Conduct regular one-on-one meetings to ensure alignment to goals and objectives.

  • Regularly assess resources needed to ensure settlement team can meet NPC's operational and strategic needs.

Qualifications (knowledge/skills/abilities/behaviors):

  • Strong financial, analytic and modeling skills including data mining, analysis, interpretation, and reporting using large scale medical or administrative data sets.

  • Ability to identify, investigate and/or escalate data and/or business issues in dynamic environment.

  • Attention to detail with high level of accuracy and documentation.

  • Strong written and oral communication skills to be applied in a variety of settings (e.g one-on-ones, presentations, group discussions).

  • Based on understanding of financial/actuarial concepts, understand/anticipate impact of settlement results to ensure accurate payments are forecast, communicated internally and externally and paid/received.

  • Ability to lead a highly productive team under rigid time constraints.

Education/Relevant Experience:

  • 7+ years related financial analysis experience

  • 3+ years of experience managing teams and working in matrix delivery organization

  • Bachelor Degree required, Master's Degree Preferred

LocationBostonTime TypeFull time


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Senior Associate Workday Financials Banking & Settlement Lead

Kpmg

Posted 1 week ago

VIEW JOBS 5/15/2019 12:00:00 AM 2019-08-13T00:00 Known for being a great place to work and build a career, KPMG provides audit, tax and advisory services for organizations in today's most important industries. Our growth is driven by delivering real results for our clients. It's also enabled by our culture, which encourages individual development, embraces an inclusive environment, rewards innovative excellence and supports our communities. With qualities like those, it's no wonder we're consistently ranked among the best companies to work for by Fortune Magazine, Consulting Magazine, Working Mother Magazine, Diversity Inc. and others. If you're as passionate about your future as we are, join our team. KPMG is currently seeking a Senior Associate in Enterprise Solutions for our Management Consulting practice. Responsibilities: * Participate in Workday Financials projects involving strategy, implementation support, and Enterprise Resource Planning (ERP) optimization related to Information Technology (IT) operations, business processes, security, and data integrity for the Workday applications * Review and map Workday business processes * Execute the day-to-day activities of Workday advisory engagements for a variety of clients including process design, package implementation lifecycle support, and project reviews * Review business processes and advise clients on system services available within the Workday application * Identify and communicate findings to senior management and client personnel Qualifications: * A minimum of three years of enterprise resource planning (ERP), Financials implementation and upgrade experience * Bachelor's degree in an appropriate field from an accredited college/university * Completion of one full implementation with Workday Financials and Workday certification in Financials or Integration (Please note that any candidate hired by KPMG into this position that doesn't currently the aforementioned certification will be required to secure one within three months from the commencement of employment) * Strong verbal and analytical skills with the ability to write at a publication quality level * Detailed understanding of ERP System concepts and general module functionality * Travel may be up to 80-100% * Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm's compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please. Kpmg Boston MA

Senior Manager, Provider Settlement

Bluecross And Blueshield Of Massachusetts