Finance Operations Lead
Mass General Brigham
Summary
The Payer 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 Mass General Brigham providers. The group evaluates key health policy, healthcare payment and market issues that arise from or are addressed through the system's relationship with Medicare, Medicaid and commercial health insurance plans.
Job description
Job Summary
The Payer 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 Mass General Brigham providers. The group evaluates key health policy, healthcare payment and market issues that arise from or are addressed through the system's relationship with Medicare, Medicaid and commercial health insurance plans.
- 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 programs
Duties and Responsibilities
- Serving as team lead, optimize data and analytic processes to improve timeliness and quality
- Serve as a trusted subject matter expert in healthcare contract finance, independently leading complex financial analyses, reporting, and strategic initiatives
- Proactively identify risks, opportunities, and process improvements, delivering timely, data-driven recommendations
- Manage multiple priorities with minimal oversight, anticipate stakeholder needs, resolve issues promptly, drive cross-functional alignment
- Identify related issues that require a decision by leadership and organize research and analyses to develop options and recommendations
- Develop presentation materials laying out context, facts, analyses and options for corporate business leaders and provider organization leadership
- Evaluate hospital and physician reimbursement, including assessment of changes to fee schedules and payment policies, development of acute hospital pricing strategy, alternative payment arrangements, and impact of Medicare changes on commercial insurer rates
- Participate in negotiation sessions with third party payers regarding hospital and physician reimbursement issues
- Develop and review related contract language in collaboration with Contracting and Office of General Counsel colleagues and lead time-sensitive valuation of complex negotiation proposals
- Maintain constructive, professional relations with third party payers
- Oversee implementation of contract provisions, working closely with hospitals, physician organizations, revenue cycle and revenue finance/budget
- Serve as a resource for questions regarding contract reimbursement and related issues; manage ad hoc requests
- Review junior staff members' analytic output prior to manager's review
- Ensure work of Contract Finance is staffed reflecting analysts' capacity, skills and interests; develop, monitor and adjust workplans
- Mentor and oversee professional development of analytic staff and contribute to employee engagement efforts
- Participate in and/or facilitate department staff/related committee meetings
- Train and advise junior staff members on applications (e.g., SQL, Alteryx, Tableau), complex modeling of value-based care methodologies and valuations, and create analytic resources
- Conduct data analytics including database querying, data validation and interpretation, complex financial modeling and scenario building, and provide business insights to help build the forecasting model
- Build contract terms into workflow to model the reimbursement rates
Requirements
- Bachelor's degree in Finance, Accounting, Healthcare Policy/Management, Healthcare Administration or a related field
- Master's Degree in a related field preferred
- 5+ years of healthcare financial analysis, budgeting or financial management experience required
- Experience in managed care or hospital reimbursement working with payor and complex reimbursement methodologies including transplant pricing/modeling, drug pricing/trends
- Experience creating standards for analytic approach
- Experience writing standardized analytic plans/workflows applicable across departmental projects
- Experience using advanced SQL and Access
- 3+ years using Alteryx for advanced data analytics
- 3+ years using Microsoft Office suite, particularly Excel, Word and PowerPoint
- 2+ years leading projects that influence the strategic direction and decision making of an organization
- 2+ years training, mentoring, and developing staff members
- A skills assessment may be required as part of the interview process focused on advanced SQL and Access
Benefits
- Health insurance
- Career advancement opportunities
- Differentials
- Premiums
- Bonuses
- Recognition programs
Company overview
Mass General Brigham is one of the largest integrated healthcare delivery systems in the United States, formed through the merger of Massachusetts General Hospital and Brigham and Women's Hospital. Based in Boston, Massachusetts, this academic medical center system operates multiple hospitals, specialty facilities, and community health centers throughout New England. The organization is renowned for its world-class patient care, cutting-edge medical research, and comprehensive medical education programs. As a teaching affiliate of Harvard Medical School, Mass General Brigham trains the next generation of healthcare professionals while advancing medical science through groundbreaking research initiatives. The system provides a full continuum of healthcare services, from primary care and preventive medicine to complex specialty treatments and emergency services. With a focus on innovation and patient-centered care, Mass General Brigham consistently ranks among the top hospital systems in the nation for clinical excellence and research output.