Senior Network

1 month ago

Canton, United States Harvard Pilgrim HealthCare Full time

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click .

Job Summary

Working under the direction of the Director or Senior Manager, the Senior Analyst will be part of a team responsible for the development, negotiation, monitoring and reporting of the contractual agreements with health care providers and institutions. Responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions (as well as finding improvements) and ad hoc requests. The Senior Network & Provider Analytics Analyst may also serve as a project manager and/or lead cross functional teams for certain related projects.

Key Responsibilities/Duties – what you will be doing

Responsible for designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements. Based on detailed analytics, create actionable information that results in identifying trend drivers and opportunities for improvement in Point32Health and provider performance. Must demonstrate ability to translate complicated and technical analytics into concise and easily understood recommendations.Work independently to identify and present cost avoidance and cost recovery opportunities.Perform financial & utilization analytics required by other departments within Point32Health including Medical Management, Contracting, Payment & Policy, etc.Utilizing in-depth understanding of reimbursement methodologies and trends in managed care finance, lead the development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network.Responsible for ongoing communication with customers, providing project status, resolving issues, coordinating continued involvement to meet original expectations, or jointly agreed upon adjusted expectations.Other duties and projects as assigned.

Qualifications – what you need to perform the job

Bachelors in Business Administration, Finance, Health Services required; Masters preferred5-7 years of business experience, preferably in managed care or provider environment.Advanced Excel skills; proficiency with SAS/SQL programming requiredIn-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment. In-depth health care reimbursement and managed care business knowledge with specialized technical and analytical skills.Strategic thinker, with strong analytic and problem-solving skills. Strong interpersonal and collaboration skills, and the ability to work in a team environment required.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

Medical, dental and vision coverage

Retirement plans

Paid time off

Employer-paid life and disability insurance with additional buy-up coverage options

Tuition program

Well-being benefits

Full suite of benefits to support career development, individual & family health, and financial health

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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