About this role
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Manages all contracting activities with payors on behalf of Beth Israel Lahey Health Performance Network (BILHPN). Responsible for contract negotiation, as well as the development of alternative reimbursement arrangements that support a focus on quality and improving medical cost trend, which are negotiated on behalf of all BILHPN member hospitals, and physicians.
Job Description:
Primary Responsibilities:
1. Thinks strategically to identify key negotiating targets for payor negotiations. Proposes and analyzes strategic options for Senior Management that provide significant opportunity to BILHPN to maximize clinical and financial performance (including via risk arrangements, fee for service rates, infrastructure and quality support). (essential)
2. Develops and updates financial reimbursement models to inform ongoing contract negotiations. Prepares detailed contract proposals including contract terms and pricing structures, and actively participates in contract negotiations with Senior Management team. (essential)
3. Ensures that BILHPN-Payor contract documents accurately reflect negotiated terms, including editing, proposing and negotiating contract language until a final document is ready for execution. Manages execution of contract from signature process to electronic filing. (essential)
4. Acts as primary contact for all contract-related activities on assigned payor portfolio, including negotiating contracts to completion. Actively manages ongoing payor relationship. Brings outstanding contract-related operational issues to resolution, collaborating with BILHPN staff as necessary. Maintains tracking system of contract performance and operational issues to address at renegotiation. (essential)
5. Develops and maintains expertise on hospital and physician reimbursement, as well as industry standard coding and billing updates. Proactively engages payors to address changes that have the potential to negatively impact BILHPN provider reimbursement and may require contract renegotiation. (essential)
6. Actively participates in the development of strategies that promote care coordination and contract terms across all payor product types, i.e. Medicare, Medicaid strategy. Designs and performs analysis to evaluate alternative risk models and support decision-making. (essential)
7. Prepares and presents payor proposals, analysis and ongoing performance reports to Senior Management and at Committee meetings, either in presentations or through informal meetings. (essential)
8. Monitors and evaluates the potential impact to BILHPN of changes in the current healthcare environment including the activities of the Health Care Policy Commission, applicable federal and state regulations including Chapter 224 (cost containment) and programmatic changes at the State Health Connector. Analyzes publicly available data to support successful contract negotiations. (essential)
9. Acts as subject matter expert to BILHPN staff and BILHPN providers on payor contract terms and interpretation of language. Maintains database of contract information. Tracks contract renewal dates. (essential)
10. Supports and collaborates with BILHPN hospital contracting staff and physician groups to address contract issues. Works with hospital and physician group contract staff to analyze existing payor contract participation and payor renewals in order to develop a strategic plan to renegotiate PLLC and HLLC contracts into consolidated BILHPN contracts. (essential)
Required Qualifications:
1. Bachelor's degree required. Master's degree preferred.
2. 5-8 years related work experience required.
3. Ability to travel to offsite locations as needed.
4. Must have flexibility to attend meetings that are early morning or evening.
5. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web- based applications. May produce complex documents, perform analysis and maintain databases.
Competencies:
1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues.
3. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction.
4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
7. Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Social/Environmental Requirements:
1. Work requires periods of close attention to work with out interruption. Concentrated effort of up to 4 hours without break may be required.
2. Work requires constant response to changing circumstances and using new information to adjust approach and to quickly respond to new needs.
3. No substantial exposure to adverse environmental conditions
4. Health Care Status: NHCW: No patient contact.- Health Care Worker Status may vary by department
Sensory Requirements:
Close work (paperwork, visual examination), Monitor Use, Visual clarity feet, Conversation.
Physical Requirements:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
This job requires constant sitting, Keyboard use.There may be occasional Fine Manipulation using one hand.
Pay Range:
$130,000.00 USD - $159,994.00 USD
The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.