Healthcare Management Analyst (Hybrid - Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
Under the direction of the Utilization team manager to provide administrative, operational, and organizational support for the Utilization Management teams.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Researches, assesses, and processes all requests for authorization that are initiated through the call center as well as the “Student Away” phone line and e-mail.
- Authorizations or interactions are completed and documented in the HAP care management software per regulatory guidelines.
- Provides administrative support to management staff related to automated authorization processes, data integrity and error resolution, issues related to the interface of HNM data with HAP systems that affect payment of the claim, network assignment discrepancies, reversing payment denials and tracking of referral benefits.
- Provides direct and day to day resolution for issues relayed through external departments and delegates that include but are not limited Evicore (CareCore National) exception reports, which relate to the authorization and processing of outpatient referral activity.
- When indicated, contact primary care physicians and specialist providers to obtain additional information required for accurate processing of request.
- Develops authorization request review and present to the designated HAP Medical Director for approval or denial.
- Based on decisions made by designated HAP Medical Director, ensures implementation and communication of decision.
- Researches and (through working with the applicable clinical personnel) resolves benefit authorization issues which cannot be decided through application of Health Alliance Plan criteria.
- Prepares denial and approval letters in addition to other written correspondence and reports and maintains files and documents that have mandatory regulatory requirements directly impacting the company’s accreditation by NCQA and compliance with CMS and privacy policies.
- Provides Utilization Management staff support and liaison support to committees, including research and proposing appropriate guidelines/criteria.
- Actively participates in assessment and development of proposals to improve utilization patterns, reduce medical costs, enhance provider delivery system, and streamline operational aspects associated with the referral process.
- Responds to incoming calls, faxes, and mail. Facilitates resolution or triage appropriately to ensure timely follow-up to each request. Enters request received via fax into the care management system.
- Performs other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Associate’s degree required or an additional three (3) years of experience may be considered in lieu of the education requirement.
- Graduate from a Commission on Accreditation of Allied Health Education Programs (CAAHEP) preferred or Accrediting Bureau of Health Education Schools (ABHES) preferred.
- Minimum of three (3) years of experience analyzing information and coordinating projects.
- Experience using personal computers.
- Experience with medical terminology.
- Experience with medical billing code (CPT and ICD-9/10 coding), preferred.
- Experience managing multiple projects in a fast-paced client focused Environment preferred.
- Ability to handle a diverse range of situations and responsibilities preferred.
- Proficiency with windows-based software, including spreadsheet (EXCEL) preferred.
- Experience or familiarity with community support services preferred.
- Excellent verbal and written communication skills preferred.
CERTIFICATIONS/LICENSURES PREFERRED:
- Licensed Practical Nurse-LPN preferred.
- Certification by American Association of Medical Assistants preferred
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.
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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.