Director, Payer Finance
2 months ago
Reporting to the Executive Director, the Director of Payer Finance and Strategy will lead financial operations and payer strategy on behalf of the Payer Contracting & Performance department.?? The Director is responsible for the development and oversight of financial modeling for all commercial and managed government payers throughout the contracting life cycle.?? The Director will develop processes to manage the financial performance of the existing contract portfolio, provide strategic support during payer negotiations, and develop reimbursement models for novel treatments and new services.?? The Director will identify underperforming lines of business and develop mitigation strategies. The Director is responsible for ensuring budget/forecast accurately reflects existing agreements and anticipated negotiation results.??
The Director of Payer Finance is a key member of the Payer Contracting & Performance team, working alongside the Executive Director, Director of Contracting and Director of Population Health to develop and execute a cohesive payer strategy.?? The Director will design and execute strategies in fee-for-service and value-based contracting to optimize organizational revenue, margin, and growth in alignment with Dana-Farber???s mission and strategic objectives.
The Director will be involved in Institute-wide profitability analyses and special projects in support of the Chief Financial Officer and other senior members of the Finance team.?? The Director will work closely with the Financial Planning department on bidirectional projects and initiatives.
Strategic Visioning
Lead managed care financial strategy and performance monitoring on behalf of Payer Contracting & Performance department.
Establish payment models (traditional and alternative) to support the growth of clinical programming, including transplant, immune effector cell therapy, and new to market oncology drugs and technologies.
Develop strategic vision for balancing financial and business considerations with clinical initiatives, in line with legal and regulatory parameters.
Facilitate cohesive Medicare Advantage strategy for both in-network and out-of-network payers, with special consideration for Dana-Farber PPS-exempt status.
Together with the Director of Population Health, evaluate and expand value-based performance contracting with national payer network.
Provide support to Dana-Farber growth strategy with high-impact institutional reporting, dashboards and oncology trends, analysis, and pricing.
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?????????? Negotiation & Contract Lifecycle Support
Oversee extensive analytic process for payer negotiations, including volume and growth projections, proposal valuations, value-based contracting considerations, and other analyses.
Develop, standardize, and perform analyses and financial modeling required to support various strategic initiatives related to reimbursement models, provider reporting and collaboration, payor contract negotiation, and regulatory compliance.
Serve as a key member of contract negotiation committee.
Direct contracting staff and partner with colleagues to facilitate information necessary to successfully achieve above-market rate increases.
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?????????? Financial Management
Collaborate with Executive Director and other senior Finance department members in the creation and maintenance of financial management tools.
Continuously evaluate payer financial performance, ensuring that budget/forecast accurately reflects existing agreements and anticipated negotiation results.
Identify underperforming lines of business and develop mitigation strategies.
Track critical contract terms and facilitate revenue cycle operations and patient access management.
Develop and implement contract management support tools post-execution, including executive summary documents to be shared and adopted across the Institute.
Prepare and provide Institute training materials, payer and rate grids, and other tools.
Research, recommend and implement process improvements to existing payor management data and tools.
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?????????? Departmental alignment and Institutional support
Further Dana Farber???s health equity goals through expansion of payer contracting and patient access
Promote the use of Harvest, Strata, and other contract management tools to support negotiations, revenue recovery, and contract performance.
Work collaboratively with all relevant Dana-Farber stakeholders (revenue cycle, pharmacy and other clinical/operational groups) to navigate health plan reimbursement, methodology, and overall strategy.
Coordinate and prepare special report requests for information, ensuring consistency and accuracy with other published reports and financial systems.
Work with IT and other pertinent departments to research and resolve data discrepancies.
Assist Executive Director and other senior team members with the development of any ad hoc presentation materials.
Minimum Job Qualifications:
Bachelor???s degree in finance, business, mathematics, or accounting required. Master???s degree in healthcare, business, public health or health care administration strongly preferred.
10 years of experience in financial performance management required; preferably in a healthcare setting.
5 years of payer contracting experience in a healthcare setting is strongly preferred.
Familiarity with Massachusetts health insurance market and extensive experience with payer negotiations required.
Knowledge, Skills, & Abilities Required:
Advanced proficiency in Microsoft business applications, e., PowerPoint, Excel, Word.
Adept at collaborating with team members and leadership to drive successful contracting outcomes.
Ability to work effectively while managing multiple priorities under tight
The position requires the ability to translate complex contractual reimbursement terms into an easily understandable and articulate format.
Must be comfortable manipulating, interpreting, and summarizing large data sets.
Ability to work in a matrixed environment and cross collaborate with others at varying reporting levels within and external to the organization.
Capability to work independently and meet deadlines with general supervision.
Knowledge of clinical delivery systems, third party reimbursement, commercial payment methodologies and acute interest in evolving health reform.
Strata and/or EPIC experience strongly preferred. Experience with data mining, relational databases, and SQL query tools is a plus.
Proven ability to manage multiple priorities, exceptional organizational skills and superior attention to detail.
Ability to cooperate and collaborate with multiple, cross-functional teams through superior interpersonal and communication skills.
Strong decision-making, critical thinking and problem-solving skills.
Ability to work in a fast-paced, rapidly changing environment.
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