Senior Provider Contract Administrator - Health Alliance Plan - Detroit
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Responsible for provider development strategic initiatives that interface with all areas of the company and affect contractual arrangements with providers; Provide subject matter expertise for the development and implementation of network reimbursement, risk sharing and incentive models.
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Manages the design and implementation of plan-wide initiatives to: assess and control costs; improve provider quality; service and accessibility.
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Analyses and designs product specific provider reimbursement policies based on industry standards, HAP operational requirements and cost management objectives. Coordinates review, approval, and publication of provider reimbursement models.
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Communicates Provider Development initiatives and objectives internally to gain partnership from other departments for smooth process-flows; advises and interfaces with senior management to keep them apprised and seek consultation on as needed basis; represents HAP at professional organizations, events and meetings, in the community.
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Creates template contracts and drafts provider specific contracts consistent with regulatory and legal requirements and HAP contracting strategy. Manages implementation of new contractual responsibilities for HAP. Ensures integrity and accuracy of the contracts before executing. Secures necessary approvals from HAP leadership and the State of Michigan Office of Financial and Insurance Services.
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Negotiates contractual relationships, including incentive and risk sharing models, with networks, IPAs, hospitals, hospital based physician groups and other providers to attain defined corporate objectives.
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Performs and monitors sophisticated financial analysis of negotiation proposals, assigned networks and providers using primary research through GQL queries and secondary research of reports prepared by other HAP departments.
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Monitors financial, quality, service and access performance of providers, using primary research through GQL queries and secondary research of reports prepared by other HAP departments. Coordinates the development and implementation of requisite corrective action plans. Presents findings to HAP management and providers. Resolves issues in a prompt, professional, accurate and discrete manner.
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Proactively discern need for and execute ongoing process improvements, alternate options and innovative approaches as necessary;; negotiates settlements and audit recoveries; resolves issues professionally providing financial reasoning and customer service excellence
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Acts as account executive for assigned networks and providers, ensuring that all HAP departments understand and meet contracted service agreements. Coordinate problem resolution with Claims, Business Configuration Team, Health Management Services and other departments as necessary.
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Performs other related duties as assigned.
- Bachelor’s degree in Business Administration, Finance, Public Health, or related field required. Master's Degree in Business or related field of study with concentration in finance/accounting or public health strongly preferred
- Minimum of three (3) years in healthcare industry
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Minimum of two (2) years in analysis of contract documents, evaluation of the financial implications of contracts, and developing negotiating tactics and strategies.
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At least one (1) year in Provider Contracting or health plan finance preferred.
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Minimum of one (1) year of demonstrated project management skills preferred.
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Demonstrated financial analytic acumen using GQL and other similar programs to support responsibilities of job
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Win-Win style of negotiating, effectively communicating, actively listening, and client follow-up skills & techniques
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Ability to comprehend complex contracts, legal documents and business acumen of various healthcare organizations
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Work independently and effectively as a team member and inter-departmentally with minimum supervision and maximum collaboration
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Excellent analytical and decision making skills including presenting concepts and ideas clearly in individual or group sessions
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High level of organizational skills with flexibility to adapt and switch gears speedily
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Excellent written and verbal communication, including editing, and proof reading skills
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Excellent interpersonal skills, and presentation skills
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Thorough understanding of legal and business principles in health care
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Superior knowledge of Finance, its principles, applications and analysis
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Proficiency with PC and software applications including Microsoft Word, Excel, Powerpoint, Access/data base application, GQL or similar report writing software, project management
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Proficiency with Diamond preferred
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.