Health Plan Contract Administrator (Hybrid in Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
Plan, lead and manage the day-to-day operation of the Compliance Program with respect to Government programs compliance requirements. Responsible, under the direction of the Director- Compliance, to provide overall strategic direction to manage compliance with Government programs rules and regulations. Serve as a subject matter expert and consultant to HAP’s Senior Leadership, Corporate Leadership Council members, members of various business areas, and Henry Ford Health Executives on key issues associated with compliance for Government programs.
Provide summary reports of compliance initiatives and monitoring metrics for Government programs compliance activities and report to the Corporate Compliance Committee. Act as the liaison for the Compliance department, collaborating with key departments and individuals such as Human Resources, Membership & Billing, Sales, Client Services, Legal, I.T. and the Information Security Officer to ensure policies and procedures are designed, developed, and implemented to ensure compliance with Government programs regulations.
Manage investigative activities related to Government programs compliance issues and violations including coordinating with business units and departments to monitor and assess violations, ensure timely investigations and corrective actions as well as tracking of violations for the purpose of annual reporting.
NOTE: Government programs compliance oversight and regulations may be specific to Medicare, Medicaid, Office of Personnel Management (OPM) the Affordable Care Act (ACA) or the Health Insurance Portability and Accountability Act (HIPAA).
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Implement initiatives to raise awareness of Government programs compliance including Lead, plan, develop and conduct education and training activities related to compliance; Develop presentations for departments and individuals at all levels to provide compliance regulatory updates; Provide regular contributions to the compliance newsletter.
- Develop and/or revise policies, procedures, documents, forms, tools, job aids and training and awareness materials both organization wide and business area specific in accordance with Government programs regulations and obtain corporate approvals as necessary.
- Conduct annual risk assessment for Government programs compliance and create and execute an annual compliance auditing plan, including identifying and overseeing resolution of any management corrective action activities.
- Manage ongoing compliance monitoring and auditing and provide recommendations for corrective actions to the business areas.
- Manage relationship with government regulators at the state and national level for Government programs compliance and investigate and respond to all government agency inquiries and investigations.
- Identify and supply on a regular basis relevant metrics, compliance risk indicators and provide reports on Government programs compliance issues affecting key program initiatives.
- Review legal policy and regulations related to Government programs, translate those regulations into business and technology requirements, then provide consultative opinions, and facilitate compliance by working with various business areas and other stakeholders to lead multiple implementation efforts.
- Serve as subject matter expert to a variety of system-level initiatives (e.g., product development efforts, new sales channel implementations, provider initiatives, information technology advancements etc.) and ensure these key initiatives are taken from development to fruition in a compliant manner including recommending enhancements.
- Facilitate and manage compliance committees and workgroups with participants from across the organization supporting Government programs compliance.
- Oversee the intake, documentation, investigation, analysis and remediation of compliance violations and issues for Government programs compliance, including escalation to leadership and senior leadership as appropriate.
- Perform other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Business Administration, Health Administration, Public Health/Public Policy, Public Planning, Law, or other degree with relevant work experience in the healthcare industry.
- Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of academic requirements. Related experience is defined as six (6) years of experience in compliance or insurance/health plan industry.
- Master’s degree preferred.
- Three (3) years of experience in insurance/health plan industry, including:
- Experience in health plan compliance.
- Experience with ACA, Medicare Advantage Part D and Medicaid compliance regulations.
- Certification or designation in Health care compliance or Managed Care a plus.
- Working knowledge of corporate compliance policies.
- Two (2) years of experience in project management/coordination and ability to implement corporate-wide projects and initiatives of a highly complex nature.
- One (1) year of experience in leading staff in projects or supervisory/management position preferred.
- Prior compliance issue investigation and/or compliance or internal auditing experience.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â 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.
Â
Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. 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. Employee's classified as contingent status are not eligible for benefits
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.