Senior Financial Analyst

ESSENTIAL FUNCTIONS

• Works collaboratively with PNM staff and managers in support of contract negotiation and other provider payment changes:
  • Functions as the subject matter expert regarding Medicare reimbursement methodologies
  • Researches guidelines, requirements, and changes to Medicare reimbursement methodologies
  • Gathers and analyzes information from multiple sources to develop a "profile" of provider/facility facilitating a more robust contracting conversation
  • Identifies opportunities for improved savings and payment models to better align provider incentives
  • Translates business objectives into data queries and analytic models
  • Actively participates in strategy discussions with PNM and finance colleagues in discussions regarding the overall direction and objectives for specific contracts
  • Effectively interprets data and communicates findings/recommendations both orally and in writing appropriate to the audience
  • Actively participates in external provider contract meetings with PNM colleagues
• Designs and executes complex data queries and analyses to evaluate the impact of proposed and actual contractual changes
• Models various scenarios to assist PNM staff in understanding options in contracting models
• Develops ongoing means to monitor the financial/cost impact of new and existing contracts and other payment changes, including global payment and risk-sharing arrangements

• Proactively identifies opportunities to improve Mass General Brigham Health Plan's financial position through enhanced payment arrangements
• Work collaboratively with the Actuarial Team in support of ongoing Trend Analysis.
  • Design and execute queries to identify drivers of change in unit cost
  • Analyze data and quantify impact of unit cost on overall medical cost trend by category of care and by product/line of business
• Designs and executes queries and develops reports in support of state and federal regulatory requirements
• Collaborates with finance and budget staff in quantifying the impact of contract savings on overall medical expenses and trends
• Ensures the validity and accuracy of all data/information reported and presented
• Works collaboratively with IT to: enhance automation of processes; establish data warehouse standards and definitions; and to identify new tools to facilitate standard querying and reporting

• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Hold self and others accountable to meet commitments
• Ensure diversity, equity, and inclusion are integrated as a guiding principle
• Persist in accomplishing objectives, despite obstacles and setbacks, to consistently achieve results
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization

Qualifications

• Bachelor's degree required; Master's degree preferred
• At least 3-5 years of experience in accounting or finance required
• Prior experience working for a health plan or in a managed care setting preferred
• At least 4-6 years of Medicare and/or Dual Eligible Special Needs Plans analytic, IT, reimbursement, and/or contract configuration experience in healthcare highly preferred
• At least 2-3 years prior experience working with Medicare Advantage and/or Dual Eligible Special Needs Plans claims data highly preferred

Knowledge, Skills, and Experience:

• Possess strong analytic and technical skills and the ability to translate complicated data into useable information
• Experience with working in Medicare audits
• In-depth knowledge and understanding of health care claims data, coding schemes (e.g. ICD, CPT) grouping methodologies (e.g. DRG, EAPG), and risk adjustment
• Demonstrated knowledge of managed care concepts and the financial relationship between payors and providers
• In-depth knowledge and understanding of the various payment methodologies and types of contractual relationships payors have with providers, including global and bundled payments and risk-sharing arrangements
• Demonstrated knowledge of database and data structures as well as of general systems technology
• Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously
• Ability to conduct analytic work in an efficient manner with minimal re-work including effective use of the peer review process
• Familiarity with generating Medicare and state mandated regulatory filings
• Adept at documenting work and creating instructional guides
• Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally at Mass General Brigham Health Plan and externally with providers
• Creative, flexible, and self-motivated with sound judgment
• Exercises self-awareness; monitors impact on others
• Receptive to and seeks out feedback; uses self-discipline to adjust to feedback
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

Working Conditions

• This is a remote role that can be done from most US states