Finance Operations Lead

Overview

This role supports the Payer Contracting group, responsible for negotiation and management of contracts with health insurance plans and for evaluating government payment policy on behalf of the organization’s providers. The group assesses key health policy, healthcare payment, and market issues related to the organization’s relationships with Medicare, Medicaid, and commercial health insurance plans. Work is coordinated with Population Health Management, Community Health, Government Affairs, Revenue Cycle, Quality, Safety and Value, and other corporate financial functional areas.

Responsibilities

• Serve as a team lead within the Payer Contracting group, optimizing data and analytic processes to improve timeliness and quality.
• Act as a trusted subject matter expert in healthcare contract finance; independently lead complex financial analyses, reporting, and strategic initiatives.
• Proactively identify risks, opportunities, and process improvements; provide timely, data-driven recommendations to support executive decision-making.
• Identify issues requiring leadership decisions; organize research and analyses to develop options and recommendations for department and key decision makers.
• Develop presentation materials outlining issue context, relevant facts and analyses, and options for a wide range of stakeholders, including corporate business leaders and leadership of provider organizations.
• Evaluate hospital and physician reimbursement, including changes to fee schedules and payment policies; support development of the organization’s acute hospital pricing strategy.
• Evaluate alternative payment arrangements (e.g., risk, quality, bundled payments) and assess the impact of Medicare changes on commercial insurer rates.
• Participate in negotiation sessions as necessary with third-party payers regarding hospital and physician reimbursement issues.
• Develop and review related contract language in collaboration with Contracting and Office of General Counsel (OGC) colleagues; lead time-sensitive valuation of complex negotiation proposals.
• Maintain constructive, professional relationships with third-party payers to represent the organization effectively.
• Oversee implementation of contract provisions in partnership with hospital and physician organization colleagues, as well as revenue cycle and revenue finance/budget teams.
• Serve as a resource for colleague and stakeholder questions related to contract reimbursement and related issues; manage ad hoc requests in a timely manner.
• Review junior staff members’ analytic output prior to manager review.
• In collaboration with the Manager, ensure staffing for Contract Finance reflects analysts’ capacity, skills, and interests; develop, monitor, and adjust workplans as needed.
• Mentor and oversee professional development of analytic staff; contribute to department employee engagement efforts.
• Participate in and/or facilitate department staff and related committee meetings.
• Train and advise junior staff on applications (e.g., SQL, Alteryx, Tableau), complex modeling of value-based care methodologies and valuations, and create analytic resources for team reuse.
• Conduct data analytics including database querying, data validation and interpretation, complex financial modeling, and scenario building to provide business insights for forecasting models.
• Build contract terms into workflows to model reimbursement rates.

Qualifications

• Bachelor’s degree in Finance, Accounting, Healthcare Policy/Management, Healthcare Administration or a related field.
• 5+ years of healthcare financial analysis, budgeting, or financial management experience required.
• Experience in managed care or hospital reimbursement working with payors and complex reimbursement methodologies, including:
  • Creating standards for analytic approach
  • Writing standardized analytic plans/workflows applicable across departmental projects
  • Using advanced SQL and Access
• 3+ years using Alteryx for advanced data analytics and Microsoft Office suite, particularly Excel, Word, and PowerPoint.
• 2+ years leading projects that influence organizational strategic direction and decision making, and training, mentoring, and developing staff members.
• A skills assessment may be required as part of the interview process focused on advanced SQL and Access, including accessing a data source and completing a separate case study assessment intended to measure subject matter/content knowledge.

Preferred Qualifications

• Master’s degree in a related field.

Compensation & Benefits

• Pay range: $99,465.60 - $144,643.20/Annual.
• Additional compensation and benefits may include comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable.

Location & Schedule

• Remote (Monday–Friday full time, eastern standard business hours).
• Work requires a stable, secure, HIPAA-compliant working station.
• Scheduled weekly hours: 40.
• Work shift: Day (United States of America).
• Regular employee type.
• Grade: 8.
• Work location listed: 399 Revolution Drive.