Government Programs Administrator - Health Alliance Plan - Troy
General Summary:
The Medicare Programs Administrator will work with various operational departments on all the activities related to the Medicare Advantage operations for the contracts held by HAP and Alliance Health & Life Insurance Company (AHL) with the Centers of Medicaid and Medicare (CMS). This includes Data reporting, analysis, trending and project management activities for the Enrollment & Claims division that includes responsibilities focused on the following divisional segments: Enrollment & Billing (Commercial & Medicare). Act as a liaison between Information Systems, Finance, Sales, Underwriting (R3), and the Enrollment & Claims division. Coordinate system testing; enhance data integrity; and work with internal as well as external customers to create and maintain Medicare data.
Principal Duties and Responsibilities:
- Project management activities, including but not limited to effective implementation of IKA system related interfaces, development of an infrastructure to support project initiatives, process workflows, relevant and meaningful data reporting and analysis, in addition to the timely and accurate migration of IKA system enhancements.
- Participate in the development and implementation of any new products offered by HAP in the IkaSystems.
- Monitor and review the Centers for Medicaid and Medicare (CMS) regulations and requirements and ensure compliance of the IKASystems modules and internal duties.
- Coordinate the data collection, reporting, distribution, and reconciliation of all required reporting including employer RDS reports.
- Develop and maintain operational policies and procedures for the Medicare Advantage Plans.
- Work with the Medicare Operational areas, IT and Finance Divisions and the HFHS Pharmacy Management department relative to the resolution of any issues as it relates to Medicare Advantage and the IKASystems transmission of Membership data.
- When system changes occur as a result of system upgrades, system enhancements, government regulations, corporate initiatives, and other IT related changes it is vital that we ensure that the Enrollment and Claims system is able to receive, transmit, and contain accurate and relevant information by developing system related test conditions and leading the testing process, and effectively migrating changes into production.
Support departmental leadership in the preparation of in-depth reporting, pre-planning and taking a pro-active approach to project management. - Provide timely and complete communications within the organization to encourage teamwork and workflow information. Keep other departments informed of key initiatives for future planning and enhancement of operations.
- Maintain the highest level of personal and professional integrity in addition to maintaining confidentiality at all times.
- Perform other related duties as assigned.
Education Required:
- Bachelor’s Degree in Business Administration, Healthcare 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 a managed health care business environment
Preferred:
- Completion of Advanced Access, Excel, Cognos training preferred
Experience Required:
- Minimum of five (5) years of progressive experience in a healthcare or insurance environment.
- Minimum of three (3) years of experience in project development, management and/or implementation with a strong emphasis on management in a Pharmacy and/or Medicare operations.
- Minimum of two (2) years progressive analytical experience in a healthcare or managed care/insurance environment
Skills and Abilities:
- Ability to research, analyze, interpret, trend, and implement process improvement initiatives
- Strong leadership abilities across multi-disciplinary teams
- Strong interpersonal skills
- Proven managerial/supervisory skills from previous work experience.
- Excellent communication, analytical, and decision-making skills.
- Advanced analytical and statistical skills required
- Knowledge of GQL, SQL, Cognos, IKA and FACETS.
- Knowledge of EDI & SFTP file exchanges
- Advanced knowledge of Medicare processes & procedures
- Ability to adapt quickly to ever-changing organizational needs
- Ability to comprehend and suggest modification to technical computerized systems.
- Exceptional commitment to Service Excellence.
- Ability to meet with clients and vendors as needed to explain procedures, requirements, and handle problem resolution.
- Basic understanding of accounting principles.
- Basic understanding of database oriented computer systems.
- IKASystems CRM/Gateway/Commission and/or FACETS preferred
- Knowledge of Cognos and FACETS system architecture for creating databases and reports.
- Knowledge of Microsoft excel and access, project management tools, query tools to develop
- Knowledge of HAP policies, procedures and benefits.
- Have a good understanding of CMS, Healthcare operations, Pharmacy and Part D.
- Strong data and analytical skills – Attention to detail and follow through
- The ability to work effectively with all levels within the organization
- Well defined problem solving and decision making skills
- Excellent written and verbal communication skills
- Advanced knowledge of Medicare processes & procedures
- Ability to adapt quickly to ever-changing organizational needs
Overview
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 2011Malcolm 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.