Lead Project Coordinator - Claims - Health Alliance Plan - Troy (full-time)
Primary Objectives:
Design, document and update complex business models related to the Provider Operations Division Claims activities. Manage and support major system initiatives to ensure that assigned projects are produced and delivered on schedule and within budget, and meet or exceed quality standards.
Duties and Responsibilities:
- Serve as a lead resource for the Provider Operations Support team and Provider Operations Management in investigating potential errors or complex issues.
- Support Provider Operations Division initiatives and act as the internal project lead to ensure that resources are utilized in an effective and efficient manner and that desired results are achieved and monitored in relation to established goals.
- Perform UAT testing for new system application releases, product builds, and configuration changes. System testing preparation including developing and creating test conditions, test data and the building, executing and documenting of test cases. Troubleshoot system issues, including identifying, tracking and researching defects and escalating for additional updates and testing. Provide sign off recommendations to Provider Operations Management, BCT Management including TCoE.
- Design and publish Provider Operations division content on oneHAP using Sharepoint. This includes policies, procedures, and reference material. Act as the content owner of the Provider Web portal to ensure claims related data and instructions is accurate.
- Configure and maintain the Explanation Codes within Facets and ensure the applicable HIPAA reason and remark code is mapped along with member and provider responsibility that will correlate to the outbound payment files (Remittance Advice, Explanation of Benefits, 835) including quarterly CMS updates.
- Design, develop and deploy internal claims training materials for both specialized and general topics including those necessary to enhance and maintain quality and productivity. Serve as a Claims Subject Matter Expert for the Corporate Training Team.
- Design, document and update complex business models related to the Provider Operations Division activities. Monitor processes quarterly to ensure the financial and procedural content is accurate and up to date. Develop and maintain departmental policies and procedures related to activities of the Provider Operations Division with a focus on Claims and Provider Service.
- Analyze claims data to design and evaluate quality measurements and improvement programs. Monitor the progress of these improvements. This includes the automated release programs, unposted workgroups and results of corporate audit recommendations.
- Other duties as assigned
REQUIREMENTS:
EDUCATION
- Associates Degree in Education or Business Administration, or related field
- Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in claims adjudication, claim inquiry resolution, and/or claim adjustment experience.
EXPERIENCE
- Minimum of two (2) years’ experience in managing large projects of a complex nature.
- At least two (2) years’ experience in computer related areas including new product implementation
- Minimum of four (4) years of managed care /insurance related business experience
- Minimum of two (2) years’ experience in development of process and project methodologies
- Two (2) years’ experience with integrated Claim Adjudication systems preferred.
BEHAVIORS
- Nature of work requires progressive leadership, interpersonal communication, decision making, financial and technical skills.
- Must exhibit the ability to function in an autonomous manner in an unstructured and rapidly changing environment.
- High energy; strong leadership, analytical, project planning and staff motivation/coordination skills to enable efficient, timely task completion of deliverables that meet or exceed project expectations.
- Demonstrated ability to function in a creative, “out of box” thinking in order to develop original solutions to overcome roadblocks and meet or exceed project requirements and expectations.
- Excellent written and verbal communication skills are essential.
KNOWLEDGE
- Advanced analytical and statistical skills required
- Knowledge of business principles and functions along with managed care principles and procedures
- Knowledge of core claim processing systems.
- Knowledge of Microsoft products, project management tools and query tools to develop reports
- Ability to adapt quickly to ever-changing organizational needs
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other health-related entities throughout southeast Michigan, providing a full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care. The health system also is a major economic driver in Michigan and employs more than 24,600 employees. Henry Ford is a 2011 Malcolm Baldrige National Quality Award recipient. The health system is led by President and CEO Wright Lassiter III. To learn more, visit henryford.com
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.