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Health Policy and Contracting Specialist

2 months ago

Somerville, United States Mass General Brigham Full time

Description:

Role Overview:

The Payer Strategy and Contracting group is seeking a candidate with a strong interest in analyzing health policy and reimbursement issues facing complex, integrated healthcare delivery systems. The group is responsible for the negotiation and management of contracts with health insurance plans and third-party payers on behalf of Mass General Brigham providers. The Payer Strategy and Contracting group evaluates key health policy, healthcare payment, and healthcare market issues in the context of Mass General Brighams strategy and relations with commercial payers, Medicare, and Medicaid. Examples of issues include:

  • Payment and reimbursement issues

  • Healthcare reform and regulatory issues

  • Value-based care, including risk sharing and pay-for-performance quality incentive arrangements

  • Reimbursement for innovative therapies and services

  • New care models such as telehealth and home-based care

  • Price transparency

  • Provider network development

The Health Policy and Contracting Specialist will support the Payer Strategy and Contracting group in the development of strategies for negotiation, analysis, implementation, and ongoing maintenance of Mass General Brigham contracts and related health policy issues associated with these contracts. Day-to-day responsibilities include, but are not limited to: researching and assessing health care issues (e.g., health care policy, health care payment, financial, and related internal provider operational issues, etc.); assisting in the development of presentation materials for a variety of audiences (including senior Mass General Brigham leadership); assisting in the organization of negotiations with health insurance plans and other constituents; assisting in the development of clear and concise written materials (project plans, presentations, proposals and contract documents); and demonstrating intellectual ownership by developing a strong understanding of contract provisions and communicating such issues to Mass General Brighams operations and provider teams (described broadly as: hospitals, physicians, health centers, central billing and operations areas, and clinical program areas).

The Health Policy and Contracting Specialist must possess strong strategic and critical thinking skills, have the ability to translate complex information into simple terms, have strong organizational and project management skills, have the ability to work as part of a team in a matrix environment, possess strong written and verbal communication skills, and have the ability to understand and integrate financial data as part of key decision support processes.

Principal Duties and Responsibilities:

  1. Act as coordinator for Mass General Brighams interdepartmental workgroup teams responsible for negotiating contracts and researching health policy issues as it related to Mass General Brighams contracts with external health insurance plans
    • Research and organize information required for contract negotiations (health care policy, health care payment, financial, and related internal operational issues, etc.)
    • Assist in the development of negotiating strategy and tactics

    • Assist in project management for external contract negotiations, including tracking issues and key decisions that have been made and effectively managing projects to completion
    • Participate in negotiation sessions with health insurance plans

  2. Build relationships and maintain communications with counterparts at health insurance plans, constituents within Mass General Brigham and other key stakeholders
  3. Collaborate with system wide Mass General Brigham constituents to generate analysis of key questions and concerns that should be integrated into contract negotiations; synthesize results for decision support/ presentation to a variety of audiences

  4. Develop complex presentation materials for a variety of audiences, including senior leadership

  5. Develop and document written proposals incorporating financial and non-financial contract terms

  6. Interpret contract language and respond to questions from internal and external constituents

  7. Other responsibilities as assigned (will grow with experience)
Qualifications:

Qualifications:

  1. Proficiency in Microsoft Word and PowerPoint

  2. Experience with Microsoft Excel

  3. Bachelors degree required (Masters preferable) in related fields such as business, health care administration, health care management, finance or law

  4. Healthcare background and/or previous exposure to health care policy required

  5. Prior contracting experience is not required the skills and competencies below are most critical

  6. Experience working with external clients would be a plus

Skills/Abilities/Competencies:

  • Possess strong communication and interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization
  • Possess strong account management/customer service skills initiate and manage complex projects through all phases of project management (i.e., initiation, negotiation, implementation, regular monitoring)

  • Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds, and levels within and external to the organization

  • Ability to think critically and strategically to solve complex problems through anticipating obstacles and negotiating solutions
  • Ability to effectively conduct meetings, both formal and informal

  • Ability to take ownership of and manage workload with minimal direction from leadership and possesses the ability to learn quickly

  • Ability to interpret and synthesize quantitative and qualitative data and/or analysis and apply those findings to relevant network strategy, payer agreements, payer policies, or other business issues

Supervisory Responsibilities:

No direct reports; may indirectly provide leadership and guidance to less seasoned and new staff

Fiscal Responsibility:

No direct budgetary responsibility
Demonstrates fiscal responsibility by effectively using Mass General Brigham resources

Working Conditions:

  • Hybrid remote and office environment (desk and telephone work) with minimal regional business travel (primarily by automobile.)

  • Computer and presentation skills required. Minimal lifting

  • Location: Assembly Row: 399 Revolution Drive, Somerville, MA
EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.