Director, Ancillary Contracting

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

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 proposing and implementing new ways to do business
• Ability to take initiative and work independently while under pressure in a constantly changing environment
• Ability to balance multiple priorities, as the effective use of resources and ability to use sound judgment is critical to this role
• Ability to work with providers to understand and assess complex situations, identify opportunities for improvement, and facilitate resolutions