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 Deaconess Care Organization (BIDCO). 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 BIDCO ACO 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 BIDCO 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 BIDCO-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 BIDCO 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 BIDCO 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 BIDCO 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 BIDCO staff and BIDCO providers on payor contract terms and interpretation of language. Maintains database of contract information. Tracks contract renewal dates. (essential)
10. Supports and collaborates with BIDCO 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 BIDCO 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.
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.
