Mass General Brigham Health Plan
Senior Financial Analyst
Mass General Brigham Health Plan, Somerville, Massachusetts, us, 02145
The Senior Financial Analyst provides value-added analytic support to Provider Network Management (PNM) in meeting Mass General Brigham Health Plan's strategic objectives. S/he must have extensive experience working with Medicare and/or Dual Eligible Special Needs Plans claims data. S/he possesses in-depth knowledge of contracting and risk-sharing models and regulatory issues governing payments to providers in a Medicare Advantage and/or Dual Eligible Special Needs Plans setting. S/he independently designs and performs analyses to measure the financial impact of provider contracts and reimbursement changes. In addition, s/he effectively partners with Finance and PNM staff and managers in support of specific contract negotiations as well as broader network-wide payment models.
ESSENTIAL FUNCTIONS
Works collaboratively with PNM staff and managers in support of contract negotiation and other provider payment changes:
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
Designs and executes complex data queries and analyses to evaluate the impact of proposed and actual contractual changes
Models various scenarios to assist PNM staff in understanding options in contracting models
Develops ongoing means to monitor the financial/cost impact of new and existing contracts and other payment changes, including global payment and risk-sharing arrangements
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
Qualifications
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
Knowledge, Skills, and Experience
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.
Working Conditions
This is a remote role that can be done from most US states
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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ESSENTIAL FUNCTIONS
Works collaboratively with PNM staff and managers in support of contract negotiation and other provider payment changes:
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
Designs and executes complex data queries and analyses to evaluate the impact of proposed and actual contractual changes
Models various scenarios to assist PNM staff in understanding options in contracting models
Develops ongoing means to monitor the financial/cost impact of new and existing contracts and other payment changes, including global payment and risk-sharing arrangements
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
Qualifications
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
Knowledge, Skills, and Experience
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.
Working Conditions
This is a remote role that can be done from most US states
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
#J-18808-Ljbffr