If you're looking for a career change or you're in search of talent...

Explore New Job Opportunities Here

Director, Network & Provider Analytics

Point32Health

Point32Health

Data Science
Canton, MA, USA
Posted on Sunday, June 9, 2024

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. To learn more about who we are at Point32Health, click here.

Job Summary

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.
The Director is will closely collaborate with Commercial and Enterprise functions in delivering the business goals with a strong and collaborative relationship with Finance, Corporate Data & Analytics (CD&A), and Health Care Services, and IT to leverage enterprise solutions built to support business performance. The position will have extensive interaction with the Chief Financial Officer, Chief Actuary, Head of Health Care Services, Chief Information Officer, and other executive leaders across the Enterprise. The Director will also represent the Commercial division’s vision and thought leadership in the areas of network performance and optimization, business intelligence, analytics and insights, and key systems selection and/or enhancements.

Key Responsibilities/Duties – what you will be doing

  • 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

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

  • Bachelor's degree in business, health administration, finance or a related field
  • Master's degree preferred, or relevant experience

EXPERIENCE (minimum years required):

  • At least 10 years of progressive analytic, financial, project and/or operational experience in healthcare with 3 or more years of effective supervisory experience

SKILL REQUIREMENTS:

  • 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.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

  • Must be able to work under normal office conditions and work from home as required.
  • Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
  • May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

  • 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

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

​Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.