Senior Government Payment Policy Analyst
As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Womens Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
Were focused on a people-first culture for our systems patients and our professional family. Thats why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal developmentand we recognize success at every step.
Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk, and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
Based in Boston, Massachusetts, Partners HealthCare System is a not-for-profit, integrated health care delivery Womens Hospital and Massachusetts General Hospital, major teaching affiliates of Harvard Medical School, Partners is recognized for its world-renowned patient care, teaching and research. Partners HealthCare System includes a broad network of primary care and specialty physicians, community health centers, acute, rehabilitation, long-system offering patients a full continuum of high-quality care. Founded by Brigham and term care and psychiatric hospitals, skilled nursing facilities, and home health.
The Government Payment Policy (GPP) Team is responsible for the following functions pertaining to the Governmental Payers Revenue Stream:
Analysis and guidance in the development of public payer strategy and advocacy
Fee-for-Service payment system implementation, monitoring, revisions, updates and comments to federal and state agencies
Financial modeling of Government Alternative Payment Programs including Pay-for-Performance/Value-Based Purchasing, Readmissions Reduction, Accountable Care Organizations, Episodes of Care, Capitation, etc
Revenue projections for annual budget and five-year capital framework
Payment rules and rates informing financial statement net revenue and third party
Reporting up through the Partners Vice President for Financial Planning and Analytics, GPP works closely with entity CFOs and Finance leadership and staff throughout the System on a broad range of government payer issues. GPP also works closely with PHS Senior Management, Government Affairs, Population Health Management, Community Benefits and Quality, Safety & Value to advise and support advocacy strategy. Members of the team serve as key representatives and liaisons of PHS in various associations and other external bodies.
Principle Duties and Responsibilities
1. Monitor changes in legislative, regulatory and administrative activity affecting revenue from Government Payers.
In conjunction with Partners Government Affairs, outside consultants and provider associations (MHA, AHA, AAMC), provide ongoing monitoring of legislative and regulatory proposals, changes and updates.
Maintain knowledge of structure and processes and monitor activity and communications from agencies charged with oversight and implementation of government revenue programs, including Center for Medicare and Medicaid Services (CMS) and Division of Medical Assistance (Massachusetts Medicaid).
2. Develop and maintain detailed reimbursement models for all hospital sectors (acute inpatient, acute outpatient, rehabilitation, long term care, psychiatric, skilled nursing and home health) for purposes of budget, multi-year forecasting and impact analysis
Working closely with key departments within PHS Finance and Entity Finance, ensure all budget / forecasting assumptions are accurately incorporated into models and results disseminated.
Model various payment policy scenarios, including legislative proposals (e.g., deficit reduction), regulatory changes and annual payment rules
3. Perform, advise and support analyses of 1) Government Quality and Performance Programs (e.g. Medicaid Pay-for-Performance, Medicare Value Based Purchasing, and HITECH), 2) Clinical Outcome Related Payment Policy (e.g. readmissions, Hospital Acquired Conditions) and 3) Alternative Payment Proposals (e.g. Accountable Care Organization, Bundles):
In conjunction with PHS and institution leadership, develop strong working knowledge of clinical, operational and reporting requirements in order to best inform financial analyses
Draft presentations outlining policy changes and financial impact to Partners
Monitor each programs development and formulate balanced and thoughtful comment letters on behalf of Partners to state and federal agencies to promote positive change in health care
Work with corporate and hospital quality and IS leaders and staff to support the development of strategies to meet full compliance and ensure optimal performance under various programs, e.g., Medicare Value-Based Performance, Medicaid Pay-for-Performance and HITECH
Represent Partners Finance in external meetings regarding related programs
4. Provide ad hoc support, guidance and expertise regarding government payment policy, payment methodologies, rates, compliance reporting and appeals
Respond to requests from corporate and entity staff
5. Serve as resource for junior analytic staff in understanding and analyzing government payment policy
Bachelors Degree required, Masters Degree in Health Care Policy, Management or Administration strongly preferred
Five years of progressive hospital reimbursement, preferably in an academic medical center, large consulting firm or hospital association (Masters Degree in the above fields may substitute for two years of job experience)
Expert knowledge in health care payment policy, federal and state government health care legislative and regulatory processes
Strong quantitative and analytical skills (e.g. Excel modeling), writing skills, and presentation skills required, SQL experience preferred
Ability to interpret and communicate results of complex policies and analyses
Ability to work independently, prioritize projects and provide prompt and thorough follow-up
Strong commitment to accuracy and thorough documentation, as analytic products will have high profile within organization and externally
Strong customer service focus
Partners HealthCare 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.