Mass General Brigham Incorporated.
Senior Financial Analyst
Mass General Brigham Incorporated., Somerville, Massachusetts, us, 02145
You may choose to display a cookie banner on the external site. You must specify the message in the cookie banner and may add a link to a relevant policy. If you are unfamiliar with these requirements, please seek the advice of legal counsel. )* Functions as the subject matter expert regarding Medicare reimbursement methodologies* Researches guidelines, requirements, and changes to Medicare reimbursement methodologies* Gathers and analyzes information from multiple sources to develop a “profile” of provider/facility facilitating a more robust contracting conversation* Identifies opportunities for improved savings and payment models to better align provider incentives* Translates business objectives into data queries and analytic models* Actively participates in strategy discussions with PNM and finance colleagues in discussions regarding the overall direction and objectives for specific contracts* Effectively interprets data and communicates findings/recommendations both orally and in writing appropriate to the audience* Actively participates in external provider contract meetings with PNM colleagues* Proactively identifies opportunities to improve Mass General Brigham Health Plan’s financial position through enhanced payment arrangements* Work collaboratively with the Actuarial Team in support of ongoing Trend Analysis.
+ Design and execute queries to identify drivers of change in unit cost
+ Analyze data and quantify impact of unit cost on overall medical cost trend by category of care and by product/line of business* Designs and executes queries and develops reports in support of state and federal regulatory requirements* Collaborates with finance and budget staff in quantifying the impact of contract savings on overall medical expenses and trends* Ensures the validity and accuracy of all data/information reported and presented* Works collaboratively with IT to:
enhance automation of processes; establish data warehouse standards and definitions; and to identify new tools to facilitate standard querying and reporting* Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.* Hold self and others accountable to meet commitments* Ensure diversity, equity, and inclusion are integrated as a guiding principle* Persist in accomplishing objectives, despite obstacles and setbacks, to consistently achieve results* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization* Bachelor's degree required; Master's degree preferred* At least 3-5 years of experience in accounting or finance required* Prior experience working for a health plan or in a managed care setting preferred* **At least 4-6 years of Medicare and/or Dual Eligible Special Needs Plans analytic, IT, reimbursement, and/or contract configuration experience in healthcare highly preferred*** **At least 2-3 years prior experience working with Medicare Advantage and/or Dual Eligible Special Needs Plans claims data highly preferred*** Possess strong analytic and technical skills and the ability to translate complicated data into useable information* Experience with working in Medicare audits* In-depth knowledge and understanding of health care claims data, coding schemes (e.g. ICD, CPT) grouping methodologies (e.g. DRG, EAPG), and risk adjustment* Demonstrated knowledge of managed care concepts and the financial relationship between payors and providers* In-depth knowledge and understanding of the various payment methodologies and types of contractual relationships payors have with providers, including global and bundled payments and risk-sharing arrangements* Demonstrated knowledge of database and data structures as well as of general systems technology* Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously* Ability to conduct analytic work in an efficient manner with minimal re-work including effective use of the peer review process* Familiarity with generating Medicare and state mandated regulatory filings* Adept at documenting work and creating instructional guides* Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally at Mass General Brigham Health Plan and externally with providers* Creative, flexible, and self-motivated with sound judgment* Exercises self-awareness; monitors impact on others* Receptive to and seeks out feedback; uses self-discipline to adjust to feedback* Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.* Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.* Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.* Be accountable for delivering high-quality work. Act with a clear sense of ownership.* Bring fresh ideas forward by actively listening to and working with employees and the people we serve.Combat disease. Hold a hand. Help people. Impact the world.Mass General Brigham is a passionate, welcoming community where minds meet caring hearts.Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world.Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community.We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system.We recognize that increasing value and continuously improving quality are essential to maintaining excellence. #J-18808-Ljbffr
+ Design and execute queries to identify drivers of change in unit cost
+ Analyze data and quantify impact of unit cost on overall medical cost trend by category of care and by product/line of business* Designs and executes queries and develops reports in support of state and federal regulatory requirements* Collaborates with finance and budget staff in quantifying the impact of contract savings on overall medical expenses and trends* Ensures the validity and accuracy of all data/information reported and presented* Works collaboratively with IT to:
enhance automation of processes; establish data warehouse standards and definitions; and to identify new tools to facilitate standard querying and reporting* Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.* Hold self and others accountable to meet commitments* Ensure diversity, equity, and inclusion are integrated as a guiding principle* Persist in accomplishing objectives, despite obstacles and setbacks, to consistently achieve results* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization* Bachelor's degree required; Master's degree preferred* At least 3-5 years of experience in accounting or finance required* Prior experience working for a health plan or in a managed care setting preferred* **At least 4-6 years of Medicare and/or Dual Eligible Special Needs Plans analytic, IT, reimbursement, and/or contract configuration experience in healthcare highly preferred*** **At least 2-3 years prior experience working with Medicare Advantage and/or Dual Eligible Special Needs Plans claims data highly preferred*** Possess strong analytic and technical skills and the ability to translate complicated data into useable information* Experience with working in Medicare audits* In-depth knowledge and understanding of health care claims data, coding schemes (e.g. ICD, CPT) grouping methodologies (e.g. DRG, EAPG), and risk adjustment* Demonstrated knowledge of managed care concepts and the financial relationship between payors and providers* In-depth knowledge and understanding of the various payment methodologies and types of contractual relationships payors have with providers, including global and bundled payments and risk-sharing arrangements* Demonstrated knowledge of database and data structures as well as of general systems technology* Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously* Ability to conduct analytic work in an efficient manner with minimal re-work including effective use of the peer review process* Familiarity with generating Medicare and state mandated regulatory filings* Adept at documenting work and creating instructional guides* Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally at Mass General Brigham Health Plan and externally with providers* Creative, flexible, and self-motivated with sound judgment* Exercises self-awareness; monitors impact on others* Receptive to and seeks out feedback; uses self-discipline to adjust to feedback* Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.* Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.* Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.* Be accountable for delivering high-quality work. Act with a clear sense of ownership.* Bring fresh ideas forward by actively listening to and working with employees and the people we serve.Combat disease. Hold a hand. Help people. Impact the world.Mass General Brigham is a passionate, welcoming community where minds meet caring hearts.Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world.Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community.We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system.We recognize that increasing value and continuously improving quality are essential to maintaining excellence. #J-18808-Ljbffr