Blue Cross Blue Shield of Massachusetts Senior Director of Medicare & Ancillary Contracting (R00687) in Boston, Massachusetts

Are you looking for innovation? Your search is over - it happens here.

The Senior Director of Medicare & Ancillary Contracting will lead the development of innovative risk-based and other network contracting approaches to enhance BCBSMA’s Medicare & Ancillary Contracting network expansion and contract reimbursement results. BCBSMA’s provider network services over 2 million commercial members and 40,000 Medicare Advantage members. This leader will work closely with Network Planning & Contracting leadership, the Executive Director of Medicare Markets, provider organizations, and other key leaders and staff to advance Medicare & Ancillary initiatives. This leader will also collaborate on financial forecasts related to the development of our Medicare Advantage market strategy and the submission of our annual CMS bid. This position will be responsible for leading a team network professionals and it reports to the Vice President of Healthcare Contracting and Management.

Key Accountabilities:

  • Develop, manage and execute contracting strategy for our Medicare Advantage products

  • Develop, manage and execute contracting strategy and contracts for our Ancillary Provider Network

  • Build and maintain high performing Medicare Advantage and Ancillary provider networks (including limited networks) utilizing risk based structures and incentives

  • Lead and participate in the development of new provider strategies, reimbursement models, networks and approaches

  • Continually assess industry trends and payment policy at a Federal, State and National Blue Cross Blue Shield’s national delivery system level to identify potential opportunities and threats to network and payment strategies. Proactively recommend actions to address

  • In direct collaboration with key cross functional leadership, lead the development of complex risk sharing and financial arrangements and other strategic objectives for our Medicare Advantage network

  • In collaboration with Network Contracting, provide strategic direction and support to Network Contracting leadership and staff in their efforts to expand our Medicare Advantage network and risk based contracts

  • Lead Ancillary Contracting leadership and staff in the development of the ancillary provider strategy and contracts and direct required financial analyses and pay-for-performance goals

  • In collaboration with our Performance Measure and Improvement department, consult on the enhancement of Medicare risk performance reporting and provider performance support

  • Work collaboratively with key departments to ensure that contracting initiatives are consistent with other corporate initiatives – fully integrate strategies and operations across departments including Medicare Markets, Legal, Actuarial and Analysis, Network Management and Sales

  • Work closely with Network Management to ensure development initiatives comply with contract implementation requirements

  • Maximize predictable rates and meet or exceed financial goals

  • Encourage change innovation; risk taking in the following areas: Medicare Risk contract development, ancillary contract negotiation, alliance building, and strategic partnerships

  • Provide ongoing staff development and coaching in negotiation, analytics, and relationship management enable a high-performing team of provider professionals

Qualifications (Knowledge, Skills and Abilities):

  • Energetic, goal driven leader with a proven ability to deliver bottom line results who can influence and motivate leaders and staff to achieve goals

  • A strategic and analytic thinker who is able to synthesize information, assess implications and formulate plans for action

  • Expert understanding of Medicare Markets and Medicare Advantage contract development.

  • Expert understanding of ancillary provider contract development; demonstrated negotiator of complex risk deals; demonstrated strength in finance to direct necessary financial analysis; demonstrated understanding of health care reimbursement methods and strategies

  • Savvy negotiator with experience in a range of provider payment methodologies. Demonstrated experience in direct, high level negotiations with proven ability to close a deal

  • Excellent interpersonal communications skills and a high level of diplomacy to anticipate, recognize and deal effectively with politically sensitive issues

  • Broad understanding of pay-for-performance measures and models

  • Solid written/verbal communication skills; effective presentation skills; project management and planning skills critical

  • Excellent quantitative and analytic skills with ability to synthesize complex information, create and evaluate options

  • Influence results-oriented behavior through communication, motivation, teambuilding, leadership, discipline and positive attitude

Education/Relevant Experience:

  • BS/BA required; Masters preferred

  • 10+ years of progressively responsible management experience in a complex healthcare setting, demonstrated provider contracting and/or health care finance experience and team builder

  • Previous experience with Medicare Advantage and Ancillary Contracting

#LI-GK1

LocationBostonTime TypeFull time

Voted as one of the Most Admired Health Care Companies in 2014 by Boston Business Journal, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.