Job ID R2664 Full / Part Time:Full time
Under the direction of the Baystate Health/Baycare Health Partners Director of Managed Care, this position will be responsible for a wide variety of duties related to the development, implementation, and ongoing management of the Baystate Health (BH) & Baycare Health Partners (BHP) managed care contracting function. The BH & BHP health plan payer contracts contribute to the overall mission, vision and strategy of BH and BHP with a focus on the IHI triple aim initiative. Primary responsibilities include contract negotiation, administration, review and analysis of contract proposals, development of managed care strategies, and a liaison role to both external and internal customers, and other special projects.Job Responsibilities:
1)Assist in the development of an overall strategy for the managed care contracting activities for BH and BHP.Develop new managed care contracts and modifications to existing contracts with health plans.Contracts include commercial, Medicare Advantage and Medicaid managed care plans, working with both regional and national insurers. Review contract language, rate and fee proposals, complete market analysis comparisons, and evaluate proposal and present to BH & BHP senior leadership and membership.
2) Participate, develop, maintain and communicate alternative payment contracts that promote the provision of high-quality and cost-efficient care, such as pay-for-performance, bundled payments, shared-savings, risk sharing and global payment arrangements.
3) Act as a liaison to internal BH departments (eg Admitting/Registration, Patient Accounting, Revenue Advisory, Planning, etc.) & BHP physician practices, BHP Committees (eg BHP Board, Contract Review Committee, Clinical Integration Advisory Council, and Practice Managers Group), and external partners (health plan contracting and provider relations management). Develop decision support and presentation materials for stakeholders/leadership making key decisions in critical areas.
4) Understand and disseminate healthcare market and industry changes including impacts due to Affordable Care Act, Massachusetts Health Exchange and regulatory requirements and communicate the impact of these changes to the BH & BHP partners
5) Support compliance with State regulatory requirements such as the Health Policy Commission Registration of Provider Organizations (RPO) and Accountable Care Organization (ACO) Certification, Division of Insurance Risk Bearing Provider Organizations (RBPO), Center for Health Information & Analysis (CHIA) reporting.
6) Follow-up with payers to address global contracting issues encountered by Baystate Hospitals and Baycare physician practices. Ensure and interpret payer compliance to contract language and provisions, and follow-up on issues as appropriate.Attend meetings with contracted health plans to address complex operational and/or payment issues and work with stakeholders to develop internal process changes as needed.
7) Develop, review and communicate operational and clinical contract requirements. Assist with pay for performance and bonus program settlement and distribution processRequired Work Experience:
5 years Healthcare, Managed Cared, Payer expertise
Preferred Work Experience:
PHO, ACO, Provider focus or experienceSkills and Competencies:
1)Excellent communication and presentation skills, financial acumen, relationship building (payers, providers and internal Baystate/Baycare stakeholders), knowledge of antitrust laws and regulations, project management, analytic skills and attention to detail, understanding of health care reimbursement, and the ability to tactfully navigate healthcare environment with various key parties.
Bachelor of Science (Required), Master of Arts
Collaboration, Courage, Instilling Trust, Managing Conflict, Ownership, Service focus, Values Differences
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.
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