Director, Network & Provider Analytics

Point32Health • Canton, MA

4d • Hybrid

About The Position

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 .

Reporting to the Vice President of Network and Provider Performance Management, the Director of Network and Provider Analytics plays a strategic leadership role with the Provider Partnerships organization. The Director manages a team of managers and analysts, working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance. He/she oversees the development and timely delivery of relevant and meaningful financial analyses in support of Point32Health’s provider contracts and network performance for all commercial and government payor lines of business.

Requirements

• Bachelor's degree in business, health administration, finance, or a related field
• 10-15 years of progressive analytic, financial, project and/or operational experience in healthcare with 3 or more years of effective supervisory experience.
• Energetic, goal-oriented leader with a proven ability to deliver results and lead teams to achieve goals
• Strong working 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
• Prior experience with Business Intelligence tools such as MicroStrategy, Tableau or SAS
• Excellent quantitative skills with ability to synthesize financial information, create and evaluate options
• Ability to manage and direct multiple priorities across teams while meeting aggressive deadlines
• Must have proven ability to work effectively across all levels of the organization on complex issues
• Excellent verbal & written communication skills
• Energetic and proactive individual who strikes the right balance between self-initiative and collaboration with others
• Demonstrated ability to master new content quickly
• Strong analytic and technical skills with the ability to translate complicated data into useable information
• Excellent verbal and written communication skills
• Must have the ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into health care industry with an emphasis on managed care and finance related issues.

Nice To Haves

• Master's degree preferred, or relevant experience
• 10-15 years of experience in healthcare analytics, provider network management, or a related field, with a strong background in data analysis and leadership roles.
• Previous experience director-level position.

Responsibilities

• Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance
• In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider networks
• Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency.
• Oversee development of provider rates in line with negotiated terms
• Oversee the submission of regulatory submissions and requests
• Monitor, analyze and report on competitive position for all applicable Point32Health markets
• Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed
• Engage with Sales team to provide compelling information and reporting in support of employer account engagement, actively participating as a subject matter expert in cross-departmental as well as external provider and broker meetings.
• Actively represent the Provider Partnerships organization in Corporate Data & Analytics, Finance, Actuarial, Trend, Health Care Services, Information Technology, and other department and enterprise governance forums.
• Provide thought leadership, express business needs, and manage relationships with key internal constituencies
• Accountable for ensuring the team adheres to enterprise data and analytics governance standards, policies, and procedures
• Recruit, retain and develop talent. Coach and support staff in analytics, leadership and relationship management to enable a high-performing team
• Other duties and projects as assigned

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

What This Job Offers

• Job Type: Full-time
• Career Level: Director