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.

Job Summary

The Director, Ancillary Contracting leads the development and management of Point32Health’s ancillary service network. The Director manages a team of managers, whose contract management teams are responsible for reimbursement strategies, negotiating and managing implementing contracts, and providing ongoing management of the operational aspects of contract reimbursement for approximately 30 different ancillary service lines for Medicare, Medicaid and Commercial product lines. The Director also identifies opportunities to reduce medical and administrative costs by outsourcing network management and contracting for specific service lines when appropriate and negotiates and manages contracts with these key vendors that provide or arrange for medical services for Plan members.

On an ongoing basis, the Director works with key internal and external stakeholders to identify and implement new opportunities to reduce medical/administrative costs and enhance the quality of care related to ancillary health services. The Director also has responsibility for building new ancillary service networks in geographic areas where the enterprise seeks to expand one or more of its business lines.

Key Responsibilities/Duties – what you will be doing

Oversee the development, negotiation, and implementation of ancillary service provider networks for the Commercial and Government Products divisions, including the development of new networks to support geographic expansion initiatives
Lead the development and implementation of new programs, policies, and contracting strategies designed to produce medical or administrative cost savings, or assure compliance with federal and state regulations, including but not limited to alternative or value-based reimbursement strategies, product/benefit design changes, and outsourcing opportunities
Provide direction and coaching to the management team who oversee the work of a staff of Ancillary Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them
Manage the review of reimbursement to contracting allied health providers to assure compliance with negotiated financial arrangements, including the collection, analysis and interpretation of data for preparing corporate budgets, and recommendations for reimbursement and budgetary changes
Support the Ancillary Contacting team by prioritizing the needs of the lines of business to ensure staff can be successful
Other duties and projects as assigned.

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

Undergraduate degree required, with master’s degree strongly preferred

EXPERIENCE (minimum years required):

10+ years related experience in a managed health care environment, with a thorough knowledge of the health care market and the needs/concerns of health care providers, experience in complex negotiations, and a strong working knowledge of government health care programs

SKILL REQUIREMENTS:

Effective communication and presentation skills, both verbally and in writing
Contract negotiation experience is required, with the ability to understand and interpret all aspects of a contract – financial, legal, and operational with emphasis on implementation of contract terms
Detailed understanding of health care reimbursement methodologies including Ancillary Value Based Contracting and Medicare payment methodologies, as well as strong financial analytic ability
Willingness and ability to foster innovation among a team, conceptualizing and envisioning the impact of change, and proposing and implementing new ways to do business
Ability to take initiative and work independently while under pressure in a constantly changing environment
Ability to balance multiple priorities, as the effective use of resources and ability to use sound judgment is critical to this role
Ability to work with providers to understand and assess complex situations, identify opportunities for improvement, and facilitate resolutions in a timely manner
Ability to understand the nuances of Health Plans across Point32Health businesses to include Tufts Health Plan and Harvard Pilgrim Health Plan including the product lines and the unique operational and financial features associated with each
Ability to maintain effective and productive staff/management relationships, including the ability to motivate staff by fostering team spirit, an attitude of cooperation, and a commitment to the organization
Excellent interpersonal skills to work with a diversity of individuals at numerous levels within and outside the organization
Excellent computer skills, including proficiency in Microsoft Word, Powerpoint, and Excel

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.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org