Senior Director, Finance and Contracting

The Senior Director of Finance and Contracting is a shared position between BMC Finance and the ACO. A key member of the ACO leadership team and reporting to BMC’s CFO and the ACO Executive Director, he/she is accountable for system contracting, including both with payers and with ACO network providers. He/she is also accountable for ACO finances, budget and financial management systems and working with BMC finance regarding integration and impact of ACO finances and system contracts within the larger system finances. The Senior Director works with the ACO and hospital management teams, physician leadership, and ACO provider network leadership to develop and implement system contracting and finance strategies, goals and objectives. Serves as a lead negotiator on highly complex system contracts. Ensures compliance with all contractual obligations and responsible for the identification of areas for contractual improvements and optimization. Serves as key contact with health plan payers and as an internal resource to the FPP, group practice administrators, and ACO providers on contractual and financial issues. Ensures effective education and handoffs from contracts to impacted operational areas. Accountable for working with provider network to develop effective funds flow which appropriately incentivize desired behaviors and outcomes. Ensures accurate payer settlements and funds communication and distribution.

• Responsible for ACO budget development, tracking and oversight, working to ensure fiscal responsibility and success. Leads budget approval process.

• Staffs the ACO Finance Committee(s), Funds Flow committees and system contracting strategy work group efforts.

• Effectively facilitates ACO funds flow development, approval and implementation, which appropriately incentivizes desired behaviors and outcomes.

• Develops systems and processes to ensure accurate and timely fiscal management. Ensures timely financial reporting and issues resolution. Measures and routinely reports on contract performance, ensures proper booking of liabilities or receivables with BACO and hospital or BMC System.

• Works with BMC finance regarding integration and impact of ACO finances and system contracts within larger system finances. Works with others to ensure actuarial success regarding risk contracts.

• Lead communicator with ACO and BMC regarding ACO finance, funds flow and contract issues. Serves as a resource to Boston Medical Center Health Plan, FPF and ACO network to communicate salient contractual, regulatory and financial issues.

• Identifies and evaluates opportunities for optimizing performance under contractual arrangements inclusive of governmental payers and Value Based Purchasing.

• Takes the lead and works with BMC and ACO to develop policies and procedures regarding applicable contracting and financial issues, such as regarding reinsurance and reserves.

• Takes lead in developing health plan payer strategy.

• Evaluates potential and existing contracts for financial viability, strategic importance and opportunities.

• Negotiates and renegotiates rates, fee schedules and contractual obligations for BMC, physicians and ACO network.

• Oversees the negotiation of contracts with potential and renewing ACO network providers.

• Collaborates with staff to develops and maintain relationships with payers and potential and existing provider partners

• Works with and/or oversees staff participation in cross functional teams to evaluate compliance with contractual administrative and operational requirements. Oversees and ensures that administrative guidelines and operational requirements of contracts are met.

• Along with contracting and finance staff, serves as internal contact for hospital administration, legal counsel, health centers and network provider administrators on managed care contract and finance issues.

• Oversees settlement process and resolution of any issues. Coordinates the analytic and operational work related to analyzing contract rate proposals as well as any associated contract settlement issues.

• Supports evaluation of opportunities that would impact future business and service lines.

• Develops and manages ACO contract and finance managers, ensuring effective and efficient department systems and processes and developing staff to meet ACO’s current and future needs. Other work duties as assigned.

• Effective team player.