Senior Analyst - Payer Strategy & Contracting

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POST DATE 8/30/2019
END DATE 10/30/2019

Partners.HealthCare System, Inc. Somerville, MA

Somerville, MA
AJE Ref #
Job Classification
Full Time
Job Type


Serve as a member of the Payer Strategy and Contracting group, which is responsible for providing data analyses in support of the negotiation, implementation and management of Partners' contracts with health insurance plans and hospital reimbursement, as well as evaluating key health policy, healthcare payment and market issues that arise from or are addressed through Partners relations with Medicare, Medicaid and Commercial health insurance plans. Conduct research and analysis of issues related to hospital fee-for-service reimbursement, alternative payment arrangements (bundled payments, specialty drug pricing, new technology & services), price transparency, and provider subcontract arrangements. Conduct data analytics including database querying, data validation and interpretation, complex financial modeling and scenario building, as well as provide business insights to help build forecasting models. Conduct strategic analyses of hospital reimbursement, including assessment of changes to fee schedules and payment policy, the development of Partners' acute hospital pricing strategy. Build contract terms into workflow to model the reimbursement rates. Create analytic frameworks and specific data metrics and benchmarks to ensure that the data address business objectives including running strategic scenarios, reconciling baseline data with institutions, validating R and VBA results and working with consultants to develop financial models. Mentor, train, and supervise analysts to calculate, validate and update reimbursement rates and annual rate increases and term updates for Commercial Insurance Payers. Serve as a lead contributor to develop presentation materials by preparing data extracts and developing PowerPoint slides that provide analyses, facts, context of issues, along with options and recommendations, so that senior leadership is able to make informed decisions. Review and prepare documentation of complex final contract terms and language related to hospital reimbursement and related financial exhibits, in collaboration with Contracting and OGC colleagues. Contribute to or lead other Payer Strategy and Contracting projects as needed, ranging from organizational strategy to department-wide initiatives such as process improvement. Provide analyses, data organization, validation, database management and manipulation of large data sets, to support Payer Strategy and Contracting objectives around hospital reimbursement methodologies, reporting, contract negotiations, implementation and ongoing maintenance of executed contracts with health insurance plans. Provide analytic support to a variety of project work such as development and implementation of hospital reimbursement methodologies, physician fee schedule development and implementation, evaluation of the impact of hospital reimbursement methodology changes and/or other payment policy changes by using software to manipulate and model the data, assessment of alternative payment arrangements, negotiation and maintenance of provider subcontracting arrangements, the assessment of payer line margin performance for Partners facilities, including analysis of key trend drivers, production of inputs for Partners' annual and multi-year budgeting processes, and setting charges for acute hospital services. Participate in other Payer Strategy and Contracting projects as needed.

Must have a Masters degree in Healthcare Finance, Healthcare Policy/Management or MBA in HealthCare Administration or a related field and 1 year of experience in the job offered or 1 year of data analysis and database experience involving: (1) Manipulation of large data sets; (2) Database management; (3) Data querying from multiple sources and tools; (4) use of software to manipulate and model data; and (5) working with hospital reimbursement methodologies. Will accept a Bachelors degree in Public Health, Health Care Policy/Management, Health Care Administration or related field and 3 years of stated experience in lieu of Masters degree and 1 year of experience.

Mail resumes to: Thomas Colligan, HR Staffing Rep., 399 Revolution Drive, Suite 285, Somerville, MA 02145