Point32Health
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
The Senior Network Performance Analyst will be part of a team responsible for the development, negotiation, monitoring, and reporting of contractual agreements with healthcare providers and institutions. Responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions, and ad hoc requests.
Job Description
Key Responsibilities/Duties: Responsible for designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements. Work independently and/or lead a team of analysts to identify and present cost avoidance and cost recovery opportunities. Perform financial & utilization analytics required by other departments within Point32Health. 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. Support RFP work including continuous improvements to the UDS submissions and create tools required to support quick turnarounds of RFPs. 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
Certification and Licensure: Required (minimum): Bachelors in Business Administration, Finance, Health Services. Preferred: Master’s degree. Experience: Required (minimum): 3-5 years of professional experience. Preferred: 5-7 years of experience in managed care or provider environment. Skill Requirements: Responsible for the submission of regulatory requests. Coordinates and oversees the annual re-contracting of the provider network for commercial business. Works with other departments to ensure open communication relating to provider risk deals. In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers. Strategic thinker, with strong analytic and problem-solving skills. Ability to function effectively in a fast-paced environment. Working Conditions and Additional Requirements
Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule. 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, and tuition program. All applicants are welcome and 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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Key Responsibilities/Duties: Responsible for designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements. Work independently and/or lead a team of analysts to identify and present cost avoidance and cost recovery opportunities. Perform financial & utilization analytics required by other departments within Point32Health. 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. Support RFP work including continuous improvements to the UDS submissions and create tools required to support quick turnarounds of RFPs. 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
Certification and Licensure: Required (minimum): Bachelors in Business Administration, Finance, Health Services. Preferred: Master’s degree. Experience: Required (minimum): 3-5 years of professional experience. Preferred: 5-7 years of experience in managed care or provider environment. Skill Requirements: Responsible for the submission of regulatory requests. Coordinates and oversees the annual re-contracting of the provider network for commercial business. Works with other departments to ensure open communication relating to provider risk deals. In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers. Strategic thinker, with strong analytic and problem-solving skills. Ability to function effectively in a fast-paced environment. Working Conditions and Additional Requirements
Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule. 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, and tuition program. All applicants are welcome and 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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