Point32Health
Overview
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. We serve nearly 2 million members and are built on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan. Our culture emphasizes a community of care and inclusion, with a focus on equitable healthcare access and outcomes for all communities we serve. Job title:
Senior Network & Provider Analytics Job Summary
Working under the direction of the Director or Senior Manager, the Senior Network Performance Analyst is part of a team responsible for the development, negotiation, monitoring and reporting of contractual agreements with health care providers and institutions. Responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions (and identifying improvements), and ad hoc requests. The Senior Network Performance Analyst may also serve as a project manager and/or lead cross-functional teams for related projects. Key Responsibilities
Design and generate Point32Health reports and financial analytics focusing on medical cost, utilization, membership, trends, and ad hoc requirements; translate analytics into concise, actionable recommendations. Work independently and/or lead a team of analysts to identify and present cost-avoidance and cost-recovery opportunities. Perform financial and utilization analytics for other departments (e.g., Medical Management, Contracting, Payment & Policy). Lead development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network. Support RFP work, including improvements to UDS submissions and tools for quick turnaround of RFPs. Maintain ongoing communication with customers, provide project status, resolve issues, and manage expectations. Other duties and projects as assigned. Qualifications
Education
Required (minimum): Bachelor’s degree in Business Administration, Finance, Health Services Preferred: Master’s degree Experience
Required (minimum): 3–5 years of professional experience Preferred: 5–7 years in managed care or provider environments; New England health care market experience; advanced Excel skills; proficiency with Access; SAS/SQL Skills
In-depth knowledge of managed care concepts and the financial relationship between payers and providers; familiarity with health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs); health status risk adjustment Strong analytic and problem-solving abilities; strategic thinking; excellent verbal and written communication and collaboration skills; ability to work in a fast-paced environment Working Conditions
Work may be from office or from home; may require extended hours and multi-tasking Compensation & Total Rewards
Point32Health offers a competitive total rewards package, including medical/dental/vision coverage, retirement plans, paid time off, employer-paid life and disability insurance with additional options, tuition program, well-being benefits, and career development support. For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/ EEO Statement
We welcome all applicants and will consider them for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert
Point32Health warns of job posting scams where unauthorized individuals pose as recruiters. Do not pay any money as part of a job application. If you have concerns about a posting or recruiter, contact TA_operations@point32health.org
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Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. We serve nearly 2 million members and are built on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan. Our culture emphasizes a community of care and inclusion, with a focus on equitable healthcare access and outcomes for all communities we serve. Job title:
Senior Network & Provider Analytics Job Summary
Working under the direction of the Director or Senior Manager, the Senior Network Performance Analyst is part of a team responsible for the development, negotiation, monitoring and reporting of contractual agreements with health care providers and institutions. Responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions (and identifying improvements), and ad hoc requests. The Senior Network Performance Analyst may also serve as a project manager and/or lead cross-functional teams for related projects. Key Responsibilities
Design and generate Point32Health reports and financial analytics focusing on medical cost, utilization, membership, trends, and ad hoc requirements; translate analytics into concise, actionable recommendations. Work independently and/or lead a team of analysts to identify and present cost-avoidance and cost-recovery opportunities. Perform financial and utilization analytics for other departments (e.g., Medical Management, Contracting, Payment & Policy). Lead development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network. Support RFP work, including improvements to UDS submissions and tools for quick turnaround of RFPs. Maintain ongoing communication with customers, provide project status, resolve issues, and manage expectations. Other duties and projects as assigned. Qualifications
Education
Required (minimum): Bachelor’s degree in Business Administration, Finance, Health Services Preferred: Master’s degree Experience
Required (minimum): 3–5 years of professional experience Preferred: 5–7 years in managed care or provider environments; New England health care market experience; advanced Excel skills; proficiency with Access; SAS/SQL Skills
In-depth knowledge of managed care concepts and the financial relationship between payers and providers; familiarity with health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs); health status risk adjustment Strong analytic and problem-solving abilities; strategic thinking; excellent verbal and written communication and collaboration skills; ability to work in a fast-paced environment Working Conditions
Work may be from office or from home; may require extended hours and multi-tasking Compensation & Total Rewards
Point32Health offers a competitive total rewards package, including medical/dental/vision coverage, retirement plans, paid time off, employer-paid life and disability insurance with additional options, tuition program, well-being benefits, and career development support. For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/ EEO Statement
We welcome all applicants and will consider them for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert
Point32Health warns of job posting scams where unauthorized individuals pose as recruiters. Do not pay any money as part of a job application. If you have concerns about a posting or recruiter, contact TA_operations@point32health.org
#J-18808-Ljbffr