Contract Operations Specialist

As a not-for-profit organization, Mass General Brigham 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, Mass General Brigham 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. Mass General Brigham 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 Mass General Brigham 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 Population Health Management (PHM) department at Mass General Brigham aims to deliver healthcare for all by translating the evolving needs of the healthcare landscape into innovative solutions to better serve individuals, communities, and organizations.

In the healthcare industry, we are in a time like no other. Experts estimate that healthcare will evolve more in the next few years than it has in the last 50 years. We have seen governments, employers, and families struggle in the face of rising healthcare costs and a fragmented healthcare system. Patients and communities need more convenient, more affordable, and higher quality care.

We are building a team that can reimagine healthcare and design care models that meet the needs of the people we serve. We are bringing a fresh perspective and a unique approach to create impact for the greater good. By bringing together people from various disciplines and ideas from different industries, we're seeking to address the complex challenges within our healthcare system and leaning forward into a new era of healthcare.

General Overview
The Contract Operations Specialist must demonstrate a comprehensive knowledge of the specific terms between Mass General Brigham and their contracted payors. This includes an understanding of each individual payors' policies and procedures. This position requires the ability to manipulate and analyze information, effective communication skills and the ability to work as a team player as well as with various levels of staff both internally and externally.

Principal Duties and Responsibilities

Payor Relationships and Reporting

* Develop and maintain relationship with payor contacts.

* Acquire an understanding of the contract terms between Mass General Brigham (MGB) payors: recognize the impact of the contract terms to the provider's enrollment or set up (i.e., physician growth caps, primary vs. additional affiliation, group level payment, etc.)

* Produce & disseminate accurate and timely payor closure information to the Community Physicians Provider Enrollment Team

* Complete ad hoc data requests for both internal & external customers

Payor Monthly Count Reconciliation

* Download files from Provider data system and generate required audits.

* Serve as the "resident expert" or resource.

* Identify & resolve discrepancies with payor and/or RSO.

* Agree to over or under cap status for physician and midlevel counts with payor.

* Execute approved Mass General Brigham (MGB) methodology to allocate available rate slots among eligible RSOs.

* Communicate with RSOs to determine specific physicians and midlevel's to occupy available rate slots.

* Identify for payors individual MD & group level information to receive Mass General Brigham (MGB) payment rates (i.e., BCBS M# or THP Payee or HPHC TIN); communicate information in a consistent manner.

* Provide consistent data among payors for Mass General Brigham (MGB) supplemental payment team to administer process.

* Maintain extensive documentation on issues, count outcomes & processes.

* Prepare monthly spreadsheet to highlight the status of each count (i.e., # physicians and midlevel's converted to spaces, # remaining on statewide, unused open spaces, etc.)

Participate in Monthly Payor Operations meetings.

* Facilitate the resolution of identified contract implementation and/or operational issues.

Data Management

* Perform ad hoc/specific payor data requests from internal & external customers.

a. Analyze data request to determine how to extract relevant information from MD Staff Data System to the requestor
b. Evaluate purpose of data to ensure consistent with approved business needs
c. Present results in an organized, consistent, and logical manner.

* Explore and implement process improvements within department relating to management of payor data in MD Staff Data System provider data audits, administration of PCPO Groups, training materials and/or checklists as necessary to optimize staff efficiency.

* Perform related duties as assigned.

Qualifications

Required:

* B.S., B.A. or equivalent experience in health care or related field required.

* At least 3 years' experience working in a healthcare setting required.

* Proven ability to manage multiple priorities, exceptional organizational skills, and keen attention to detail.

* Ability to demonstrate professionalism and respect.

* Good verbal and written communication skills.

* Strong decision-making, critical thinking, and problem-solving skills.

* Capability to work independently and in collaboration with others, complete work and meet deadlines with general supervision.

* Ability to work in fast-paced, rapidly changing environment.

* Competency in Microsoft Word, PowerPoint, and Excel.

* Knowledge of MD Staff Data System is a plus but not required.

Skills/Abilities/Competencies

* Proven ability to manage multiple priorities, exceptional organizational skills, and keen attention to detail.

* Ability to demonstrate professionalism and respect.

* Good verbal and written communication skills.

* Strong decision-making, critical thinking, and problem-solving skills.

* Capability to work independently and in collaboration with others, complete work and meet deadlines with general supervision.

* Ability to work in fast-paced, rapidly changing environment.

* Ability to direct and collaborate with interdisciplinary groups to drive outcomes.

* An inclusive individual who thrives in a highly matrixed, collaborative, team-oriented environment

* Ability to successfully communicate & collaborate with others of different skill sets, backgrounds, and levels within and external to the organization.

* Is honest, authentic, and straightforward when working with others.

* Competency in Microsoft Word, PowerPoint, and Excel.

Working Conditions

A hybrid work model, with 2 days per month on-site; professional office setting located in Assembly Row, Somerville, MA & time spent onsite in the local entity in which the role is embedded.

Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.