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.
The Director, Ancillary Contracting leads the development and management of Point32Health’s ancillary service network. The Director manages a team of managers, whose contract management teams are responsible for reimbursement strategies, negotiating and managing implementing contracts, and providing ongoing management of the operational aspects of contract reimbursement for approximately 30 different ancillary service lines for Medicare, Medicaid and Commercial product lines.
Job Summary
The Director also identifies opportunities to reduce medical and administrative costs by outsourcing network management and contracting for specific service lines when appropriate and negotiates and manages contracts with these key vendors that provide or arrange for medical services for Plan members. On an ongoing basis, the Director works with key internal and external stakeholders to identify and implement new opportunities to reduce medical/administrative costs and enhance the quality of care related to ancillary health services. The Director also has responsibility for building new ancillary service networks in geographic areas where the enterprise seeks to expand one or more of its business lines. Job Description
Oversee the development, negotiation, and implementation of ancillary service provider networks for the Commercial and Government Products divisions, including the development of new networks to support geographic expansion initiatives Lead the development and implementation of new programs, policies, and contracting strategies designed to produce medical or administrative cost savings, or assure compliance with federal and state regulations, including but not limited to alternative or value-based reimbursement strategies, product/benefit design changes, and outsourcing opportunities Provide direction and coaching to the management team who oversee the work of a staff of Ancillary Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them Manage the review of reimbursement to contracting allied health providers to assure compliance with negotiated financial arrangements, including the collection, analysis and interpretation of data for preparing corporate budgets, and recommendations for reimbursement and budgetary changes Support the Ancillary Contacting team by prioritizing the needs of the lines of business to ensure staff can be successful Other duties and projects as assigned Education, Certification And Licensure
Undergraduate degree required, with master’s degree strongly preferred EXPERIENCE
10+ years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers, experience in complex negotiations, and a strong working knowledge of government health care programs Skill Requirements
Effective communication and presentation skills, both verbally and in writing Contract negotiation experience is required, with the ability to understand and interpret all aspects of a contract – financial, legal, and operational with emphasis on implementation of contract terms Detailed understanding of health care reimbursement methodologies including Ancillary Value Based Contracting and Medicare payment methodologies, as well as strong financial analytic ability Willingness and ability to foster innovation among a team, conceptualizing and envisioning the impact of change, and proposing and implementing new ways to do business Ability to take initiative and work independently while under pressure in a constantly changing environment Ability to balance multiple priorities, as the effective use of resources and ability to use sound judgment is critical to this role Ability to work with providers to understand and assess complex situations, identify opportunities for improvement, and facilitate resolutions in a timely manner Ability to understand the nuances of Health Plans across Point32Health businesses to include Tufts Health Plan and Harvard Pilgrim Health Plan including the product lines and the unique operational and financial features associated with each Ability to maintain effective and productive staff/management relationships, including the ability to motivate staff by fostering team spirit, an attitude of cooperation, and a commitment to the organization Excellent interpersonal skills to work with a diversity of individuals at numerous levels within and outside the organization Excellent computer skills, including proficiency in Microsoft Word, Powerpoint, and Excel 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 Compensation & Total Rewards Overview
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 We welcome all
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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The Director also identifies opportunities to reduce medical and administrative costs by outsourcing network management and contracting for specific service lines when appropriate and negotiates and manages contracts with these key vendors that provide or arrange for medical services for Plan members. On an ongoing basis, the Director works with key internal and external stakeholders to identify and implement new opportunities to reduce medical/administrative costs and enhance the quality of care related to ancillary health services. The Director also has responsibility for building new ancillary service networks in geographic areas where the enterprise seeks to expand one or more of its business lines. Job Description
Oversee the development, negotiation, and implementation of ancillary service provider networks for the Commercial and Government Products divisions, including the development of new networks to support geographic expansion initiatives Lead the development and implementation of new programs, policies, and contracting strategies designed to produce medical or administrative cost savings, or assure compliance with federal and state regulations, including but not limited to alternative or value-based reimbursement strategies, product/benefit design changes, and outsourcing opportunities Provide direction and coaching to the management team who oversee the work of a staff of Ancillary Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them Manage the review of reimbursement to contracting allied health providers to assure compliance with negotiated financial arrangements, including the collection, analysis and interpretation of data for preparing corporate budgets, and recommendations for reimbursement and budgetary changes Support the Ancillary Contacting team by prioritizing the needs of the lines of business to ensure staff can be successful Other duties and projects as assigned Education, Certification And Licensure
Undergraduate degree required, with master’s degree strongly preferred EXPERIENCE
10+ years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers, experience in complex negotiations, and a strong working knowledge of government health care programs Skill Requirements
Effective communication and presentation skills, both verbally and in writing Contract negotiation experience is required, with the ability to understand and interpret all aspects of a contract – financial, legal, and operational with emphasis on implementation of contract terms Detailed understanding of health care reimbursement methodologies including Ancillary Value Based Contracting and Medicare payment methodologies, as well as strong financial analytic ability Willingness and ability to foster innovation among a team, conceptualizing and envisioning the impact of change, and proposing and implementing new ways to do business Ability to take initiative and work independently while under pressure in a constantly changing environment Ability to balance multiple priorities, as the effective use of resources and ability to use sound judgment is critical to this role Ability to work with providers to understand and assess complex situations, identify opportunities for improvement, and facilitate resolutions in a timely manner Ability to understand the nuances of Health Plans across Point32Health businesses to include Tufts Health Plan and Harvard Pilgrim Health Plan including the product lines and the unique operational and financial features associated with each Ability to maintain effective and productive staff/management relationships, including the ability to motivate staff by fostering team spirit, an attitude of cooperation, and a commitment to the organization Excellent interpersonal skills to work with a diversity of individuals at numerous levels within and outside the organization Excellent computer skills, including proficiency in Microsoft Word, Powerpoint, and Excel 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 Compensation & Total Rewards Overview
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 We welcome all
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.
#J-18808-Ljbffr