Health Policy and Contracting Specialist

Partners Healthcare System Somerville, MA
As a not-for-profit organization, Partners HealthCare is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Partners HealthCare is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.

Our employees use the Partners HealthCare values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.


The Payer Strategy and Contracting group is seeking a candidate with a strong interest in analyzing health policy issues facing complex, integrated healthcare delivery systems. The Payer Strategy and Contracting group evaluates key health policy, healthcare payment, and healthcare market issues in the context of Partners relations with commercial payers, Medicare, and Medicaid. The group is responsible for implementing key policy positions through the negotiation and management of contracts with health insurance plans and third party payers on behalf of Partners providers. Examples of policy issues include:

* Payment and reimbursement issues

* Payment reform and alternative payment models

* Healthcare reform

* Pay-for-performance quality incentive programs

* Provider network development

* New care models such as patient-centered medical homes, urgent care, and telehealth

* Price transparency

* Accountable care organization progress and development

* Medical cost trend management

The Health Policy and Contracting Specialist will support the Payer Strategy and Contracting group in the development of strategies for negotiation, analysis, implementation, and ongoing maintenance of Partners contracts and related health policy issues associated with these contracts. Day-to-day responsibilities include, but are not limited to: researching and assessing health care issues (e.g., health care policy, health care payment, financial, and related internal provider operational issues, etc.); assisting in the development of presentation materials for a variety of audiences (including senior Partners leadership); assisting in the organization of negotiations with health insurance plans and other constituents; assisting in the development of clear and concise written materials (project plans, presentations, proposals and contract documents); and demonstrating intellectual ownership by developing a strong understanding of contract provisions and communicating such issues to Partners' operations and provider teams (described broadly as: hospitals, physicians, health centers, central billing and operations areas, and clinical program areas).

The Health Policy and Contracting Specialist must possess strong strategic and critical thinking skills, have the ability to translate complex information into simple terms, have strong organizational and project management skills, have the ability to work as part of a team in a matrix environment, possess strong written and verbal communication skills, and have the ability to understand and integrate financial data as part of key decision support processes.

Principal Duties and Responsibilities

1.Act as coordinator for Partners interdepartmental workgroup teams responsible for negotiating contracts and researching health policy issues as it related to Partners contracts with external health insurance plans

Research and organize information required for contract negotiations (health care policy, health care payment, financial, and related internal operational issues, etc.)

Assist in the development of negotiating strategy and tactics

Assist in project management for external contract negotiations, including tracking issues and key decisions that have been made and effectively managing projects to completion

Participate in negotiation sessions with health insurance plans

2.Build relationships and maintain communications with counterparts at health insurance plans, constituents within Partners and other key stakeholders

3.Collaborate with system wide Partners constituents to generate analysis of key questions and concerns that should be integrated into contract negotiations; synthesize results for decision support/ presentation to a variety of audiences

4.Develop complex presentation materials for a variety of audiences, including senior leadership

5.Develop and document written proposals incorporating financial and non-financial contract terms

6.Interpret contract language and respond to questions from internal and external constituents

7.Other responsibilities as assigned (will grow with experience)

1.Proficiency in Microsoft Word and PowerPoint

2.Experience with Microsoft Excel

3.Bachelor's degree required; Master's degree in related field preferred

4.Healthcare background and/or previous exposure to health care policy preferred

5.Prior contracting experience is not required – the skills and competencies below are most critical.

6.Experience working with external clients would be a plus.

Skills Required

1.Understanding of Health Care Market: Basic knowledge of the health care market, including common understanding of the facts, concepts and trends that are general to the industry, including Medicare and Medicaid, health care reform, and specific to Partners and the work of the department

2.Strategic and Critical Thinking: General ability to think strategically and critically; this includes the ability to broadly think about a problem by assessing relevant information and developing potential well reasoned recommendations or solutions in the context of the environment and organizational priorities

3.Leadership – Influencing Others: Works well as part of a team in a matrixed environment with multiple constituents.

4.Account Management: Great customer service skills, providing accurate and reliable information to constituents and maintaining professional relationships with key contacts.

5.Negotiation: Supports team in efforts to reach agreement based on the merits of the issues and to create an outcome that has mutual benefits for the parties involved.

6.Project Management: (2) Effectively supports team in project initiation, monitoring progress, anticipating obstacles and providing concise updates in a timely manner.

7.Communication: (2) Strong verbal and written communication skills; able to convey complex issues, lay out well reasoned arguments, and organize and present findings and recommendations

8.Analysis & Reporting – Analytic Skills: (2) Able to support team in interpreting and synthesizing quantitative and qualitative data and/or analysis and apply those findings to relevant network strategy, payer agreements, payer policies, or other business issues.

9.Intellectual Ownership: (2) Able to understand an issue from a broad and detailed perspective

10.Analytic & Reporting – Technical Skills

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