Vice President – System Contracting & Value-Based Reimbursement
PRINCIPAL
DUTIES AND RESPONSIBILITIES:
Collaborates with
Executive leadership to develop system contracting strategy and serve as a key contracting strategist to ensure HFHS is well
positioned for transition from volume to value-based reimbursement.
Leads all payer negotiations for HFHS on behalf of its hospital
and physicians for pay-for-performance, bundled payments, shared savings/risk,
and traditional fee-for-service arrangements, including evaluation of reimbursement terms,
contract language, risk-based arrangements and operational implications. Payor products include CMS MSSP, commercial,
Medicare Advantage, Medicaid HMOs, Direct to Employer, and other governmental
and international payors.
Supports analyses of strategic and process improvement
initiatives of Population Health and Clinical Networks to reduce cost and
create value on a per member basis.
Reviews monthly with Operational partner the financial
trends and themes emerging from risk and value-based contracts to assist in
identifying necessary course correction.
Oversees monthly
accounting process for risk sharing arrangements and financial analysis of value
based contracts.
Leads implementation,
maintenance and use of expected reimbursement contract modeling tools.
Develops and maintains hospital & physician
contract management systems and staff to validate actual payments to expected
payments for services.
Oversees ongoing review
and renewal of existing payor contracts.
Maintains expertise in
reimbursement methodologies and regulatory changes as they apply to payor
contracts.
Serves on appropriate strategic
planning and policy-making committees.
Bachelor’s Degree in Finance
or Health Care Administration. Master’s Degree and Certified Public Accounting
experience preferred.
Ten
years of progressively more responsible experience in contracting and
reimbursement, 5+years of senior leadership experience preferred.
Extensive experience & knowledge in:
Value-based care models, including
bundle payment negotiation, pay-for-performance initiatives, shared savings,
risk pools, and capitation.
Negotiations with C-Suite executives internally
as well as externally in the employer and payer arenas
Aligning strategic partnerships
between contracting and medical management , clinical and administrative
operations.
Regulatory environment changes
Extensive knowledge of language interpretation
in managed care contracts
Rate methodologies
utilized for Hospitals, Physicians, ASCs and Insurance companies
Ability
to communicate in clear, concise terms
Well-developed
conceptual and analytical skills
High
level of interpersonal, management and organizational skills
Ability
to motivate teams to produce quality materials with tight timeframes and
simultaneously manage several projects
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.