Product Consultant (Medicare) - Health Alliance Plan - Southfield
GENERAL SUMMARY:
Functions as liaison between HAP departments, committees, state regulatory agencies, and third parties as requested. Assist and support strategies and approaches to increase performance and competitive positioning of HAP’s products. Supports initiatives that promote product growth and retention strategies. Ensures that all efforts align with state and federal regulatory requirements set forth in the Patient Protection and Affordable Care Act (PPACA) and Department of Insurance and Financial Services (DIFS) and the Centers for Medicare and Medicaid Services (CMS). Monitors industry trends and competitor offerings and determines the value proposition of new functionality to HAP. Facilitates and documents business requirements development efforts to ensure business needs are met. Interacts with technical and vendor partners and ensures that business requirements are fully understood to ensure alignment with delivered solution. Collaborates with business partners that impact HAP products to identify process improvement opportunities, and leads small and larger scale process improvement efforts with defined metrics to measure outcomes.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Supports high profile initiatives impacting HAP products. Collaborates with impacted business areas including product development, operations, information technology etc., to assess potential system and operational impacts and incorporate feedback. Supports the development of robust, clearly defined and documented business requirements to ensure that business needs are clearly met and represented. Supports development of business test cases for product specific initiatives.
2. Assist the Lead Product Consultant/Product Manager to lead in working with cross-functional project workgroups to ensure that project resources are utilized in an effective and efficient manner. Coordinate all activities relevant to assigned projects including overseeing task/deliverable follow-up activities, scheduling meeting and managing meeting minutes. Coordinate I/T efforts to ensure expeditious response and resolution of system problems/issues; escalate as appropriate.
3. Contributes to business case development to determine value proposition of new or enhanced technical solutions. Works closely with operational areas to determine operational efficiencies associated with the new technology and documents findings in prescribed templates/formats.
4. Serve as the SME for details on product attributes and benefit features. Contributes to training and product updates as appropriate. Seeks input from operational leaders to identify process improvement opportunities within their respective areas. Supports process re-design efforts with defined metrics to measure improvements over time.
5. Monitors industry and competitor products, trends, and technical solutions and documents findings.
6. Takes ownership of assigned initiatives and serves in a supporting role to ensure delivery of appropriate documentation.
7. Maintains active knowledge of Health Care Reform, Health Insurance Market and Government Products to ensure that technical solutions/ functionality align with regulations and industry trends.
8. Assists with coordination of regulatory site visits and/or audits as needed.
9. Investigates and responds to requests for information from regulatory agencies on behalf of the corporation.
10. Utilizing various tools (i.e. Lexis/Nexis, SERFF, internet) conducts research as assigned in corporate matters. Reviews, analyzes and summarizes key findings of documents, proposals, developments as requested
11. Works with Finance/Underwriting to develop a streamlined process for rider filings, certificate of coverage and updates. Creates and maintains centralized repository for same.
12. Assists with development and maintenance of annual filing schedule for all common certificates of coverage, including Medicare Advantage and Medicaid as applicable.
13. Representative for:
- Benefit Implementation Team
- Rider Evaluation Committee
14. Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's Degree required, preferably in Business Administration, Health Care Management or related field or an additional six (6) years of experience in business process redesign/analysis and/or leading projects may be considered in lieu of education requirement.
- Minimum of three (3) years of Health Care related business experience.
- Minimum of two (2) years in business process redesign and analysis.
- At least two (2) years in leading or participating on project teams and/or workgroups.
- Proficient in MS Office and related applications.
- Experience with presentations and public speaking preferred.
- Self-motivated and able to work independently; highly organized.
- Strong technical, analytical and problem-solving skills
- Ability to manage and lead multiple activities among various departments and work independently to meet timelines.
- Excellent written, oral and interpersonal skills.
- Ability to work collaboratively and professionally with all levels of the organization.
- Ability to adapt to a constantly changing environment.
- Knowledge of managed care concepts and healthcare industry.
- Knowledgeable in project management and time management techniques.
- Willing to work extended hours based on department’s priorities.
- Knowledge of broad range of Health Care delivery models (HMO, PPO, Medicare & Medicaid)
- Strong analytic and research background
- Experience in managing multidisciplinary projects/initiatives
- Experience in performing in-service training to multidisciplinary audience
- Ability to collaborate and interact with executive/senior leadership
- Proficiency operating personal computer and associated software programs, including but not limited to, Word, Excel, Power Point
- Proficient at researching matters (including regulations and service standards) via internet and public websites
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. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. 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. 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.