Senior Network & Provider Analytics

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Working under the direction of the Director or Senior Manager, the Senior Network Performance Analyst will be part of a team responsible for the development, negotiation, monitoring and reporting of the contractual agreements with health care providers and institutions. Responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions (as well as finding improvements) and ad hoc requests. The Senior Network Performance Analyst may also serve as a project manager and/or lead cross functional teams for certain related projects.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Responsible for designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements. Based on detailed analytics, create actionable information that results in identifying trend drivers and opportunities for improvement in Point32Health and provider performance. Must demonstrate ability to translate complicated and technical analytics into concise and easily understood recommendations.
• Work independently and/or lead a team of analysts to identify and present cost avoidance and cost recovery opportunities.
• Perform financial & utilization analytics required by other departments within Point32Health including Medical Management, Contracting, Payment & Policy, etc.
• Utilizing in-depth understanding of reimbursement methodologies and trends in managed care finance, lead the development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network.
• Support RFP work including continuous improvements to the UDS submissions and create tools required to support quick turn arounds of RFPs.
• Responsible for ongoing communication with customers, providing project status, resolving issues, coordinating continued involvement to meet original expectations, or jointly agreed upon adjusted expectations.
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Education

• Required (minimum): Bachelors in Business Administration, Finance, Health Services
• Preferred: Master’s degree

Experience

• Required (minimum): 3-5 years of professional experience.
• Preferred: 5-7 years of experience in managed care or provider environment. New England health care market experience. Advanced Excel skills; proficiency with Access; SAS/SQL.

Skill Requirements

• Responsible for the submission of regulatory requests.
• Coordinates and oversees the annual re-contracting of the provider network for commercial business.
• Works with other departments, including Network Contracting, Provider Settlement, Accounting, Trends and Reserving to ensure open communication relating to provider risk deals.
• In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment. In-depth health care reimbursement and managed care business knowledge with specialized technical and analytical skills.
• Strategic thinker, with strong analytic and problem-solving skills. Strong interpersonal and collaboration skills, and the ability to work in a team environment required.
• Ability to function effectively in a fast-paced environment. Proven organization, facilitation, and conflict management skills. Excellent oral, written and presentation skills
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