Director of Provider Payment Innovation Analytics

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POST DATE 8/12/2016
END DATE 10/9/2016

BMC HealthNet Plan Boston, MA

Boston, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
Bachelors Degree


Job Summary:

The Director of Provider Payment Innovation Analytics is an integral member of the Finance leadership and provider strategy teams. The Director will be responsible for measurement and reporting of provider profiles, negotiation of financial provider contract terms including valuation of provider settlements, and oversight of provider payment policy. In addition to these core responsibilities, the Director will play a significant role in the development and evolution of provider payment methodology, measurement, and funds flow innovations with Accountable Care Organizations (ACOs). This is a high exposure position, both internally and externally the Director will work closely with the CFO and leaders in Finance, Operations, Network Management, the Office of Clinical Affairs, and ACOs.

Key Functions/Responsibilities:

* Develop, maintain, and foster financial relationships with providers. Assist with negotiations of revised and new financial terms as needed to support BMCHP strategy.

* Direct the development and oversight of models assessing the financial impact of proposed provider contracting terms.

* Direct development of shared savings budgets and provider reporting and performance assessment.

* Develop, maintain, and leverage a best in class provider reporting and analytics infrastructure to support ACOs, ensuring data integrity.

* In collaboration with BMCHP ACO team members and in consultation with ACO leaders, identify actionable financial opportunities and quantify potential impact.

* Develop processes and standards to ensure data and reporting integrity. Ensure that data and reporting integrity is maintained in times of significant change.

* Direct activities required to develop provider reimbursement policies and ensures their consistency with operating principles, contract terms, and current/future business practices

* Direct the financial valuation activities related to fee schedule and regulatory payment policy changes

* Lead efforts to ensure that corporate payment policies meet the strategic goals of the Plan, including leading the Payment Policy Steering Committee.

* Identify, evaluate, and lead efforts to implement cost savings initiatives related to payment policy change opportunities.

* Lead development and use of re-pricing models used to benchmark current payment terms.

* Direct the assessment and analysis of various reimbursement models such as DRGs, EAPGs, and bundled payments.

* Lead the development of tools and reporting to support provider contracting strategy

* Lead the provider settlement process, including alternative payment model settlements, through accurate and timely measurement and communication of provider contract terms.

* Direct the preparation and submission of annual Relative Pricing and TME state filings

* Collaborate with project teams to structure contract and service agreements which balance risk and reward for both parties. Ensure each relationship is managed appropriate to the scope of the engagement.

Supervision Exercised:

* Directs 5-10 staff within multiple functions

Supervision Received:

* General supervision is received weekly.



* Bachelor s Degree in Finance, Health Care Administration, or related field required.


* Master s Degree preferred.

* FSA/ASA preferred but not required.


* Eight + years progressively responsible experience in health care financial forecasting and pricing required. Four years management experience required.


Certification or Conditions of Employment:

* Pre-employment background check

Competencies, Skills, and Attributes:

* Expert analyst with an ability to translate findings into real world solutions.

* Ability to use well developed interpersonal skills to direct and influence the efforts of others, both

* internally and externally required.

* Must be able to conceptualize and envision the impact of change, and propose new ways to do

* business.

* Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze

business problems. Project management skills a plus.

* Strong communications skills, both verbal and written, are required. .

* Strong understanding of health care data and analytical methodologies.

* Strong team player.

* Effective collaborative and proven process improvement skills

Working Conditions and Physical Effort:

* Work is normally performed in a typical interior/office work environment.

* No or very limited physical effort required.

* No or very limited exposure to physical risk


Boston Medical Center Health Plan, Inc. (BMCHP) is a not-for-profit health maintenance organization founded in 1997 by Boston Medical Center. BMCHP’s Massachusetts business, BMC HealthNet Plan, serves over 260,000 members across the state and offers coverage to New Hampshire’s 115,000 Medicaid managed care program recipients. In New Hampshire, the organization operates under the name Well Sense Health Plan.Healthcare is one of the most dynamic and rapidly growing industries in the U.S. Working at our organization will challenge your knowledge and skills, while providing you with opportunities to participate in training and development programs that will help you achieve your professional goals. Whether it’s your first job or you want to take the next step in your career, we offer many rewarding positions in a welcoming, diverse work environment. Learn more about available job openings today.

Company Size:
501-1,000 Employees
Health Care
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2 Copley Place Suite 600
Boston, MA 02116

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