Director, Ancillary Contracting

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

The Director, Ancillary Contracting leads the development and management of Point32Health’s ancillary service network. The Director manages a team of managers, whose contract management teams are responsible for reimbursement strategies, negotiating and managing implementing contracts, and providing ongoing management of the operational aspects of contract reimbursement for approximately 30 different ancillary service lines for Medicare, Medicaid and Commercial product lines. The Director also identifies opportunities to reduce medical and administrative costs by outsourcing network management and contracting for specific service lines when appropriate and negotiates and manages contracts with these key vendors that provide or arrange for medical services for Plan members.

On an ongoing basis, the Director works with key internal and external stakeholders to identify and implement new opportunities to reduce medical/administrative costs and enhance the quality of care related to ancillary health services. The Director also has responsibility for building new ancillary service networks in geographic areas where the enterprise seeks to expand one or more of its business lines.

Job Description

• Oversee the development, negotiation, and implementation of ancillary service provider networks for the Commercial and Government Products divisions, including the development of new networks to support geographic expansion initiatives
• Lead the development and implementation of new programs, policies, and contracting strategies designed to produce medical or administrative cost savings, or assure compliance with federal and state regulations, including but not limited to alternative or value-based reimbursement strategies, product/benefit design changes, and outsourcing opportunities
• Provide direction and coaching to the management team who oversee the work of a staff of Ancillary Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them
• Manage the review of reimbursement to contracting allied health providers to assure compliance with negotiated financial arrangements, including the collection, analysis and interpretation of data for preparing corporate budgets, and recommendations for reimbursement and budgetary changes
• Support the Ancillary Contacting team by prioritizing the needs of the lines of business to ensure staff can be successful
• Other duties and projects as assigned.

EDUCATION, CERTIFICATION AND LICENSURE:

• Undergraduate degree required, with master’s degree strongly preferred

EXPERIENCE (minimum years required):

• 10+ years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers, experience in complex negotiations, and a strong working knowledge of government health care programs

SKILL REQUIREMENTS:

• Effective communication and presentation skills, both verbally and in writing
• Contract negotiation experience is required, with the ability to understand and interpret all aspects of a contract – financial, legal, and operational with emphasis on implementation of contract terms
• Detailed understanding of health care reimbursement methodologies including Ancillary Value Based Contracting and Medicare payment methodologies, as well as strong financial analytic ability
• Willingness and ability to foster innovation among a team, conceptualizing and envisioning the impact of change, and proposi