Healthcare Provider Contracts Administrator (Hybrid) - Health Alliance Plan
Are you a contracts coordination and negotiation guru? Do you have experience interfacing with large healthcare provider and physician groups? Do you pride yourself on building and nurturing relationships? If so, this Provider Contracts Administrator opportunity may be the role for you!
This hybrid role will be a blend of remote and in person work. Attendance at team meetings and visiting providers throughout the HAP member service area required.
GENERAL SUMMARY:
Responsible for provider contracting strategic initiatives that interface with all areas of the company and affect contractual arrangements with providers; manage and maintain operational and technical aspects of provider contracting; builds rates and reimbursement terms, manage configuration process for accurate reimbursement, maintain database related to reimbursement and rates, managed multiple projects simultaneously, and negotiates favorable contracts and builds integrity in contractual relationships within the scope of responsibility and subject matter expertise.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Manage rate configuration process for contractual relationships, including incentive and risk sharing models, with networks, IPAs, hospitals, hospital based physician groups and other providers to manage costs and improve quality, service, and access.
- Coordinates configuration for the contracting process by providing workflow documents, financial summaries, guiding principles, amendments, etc.
- Acts as subject matter expert for provider contracting operations and technical areas using Contract Management Software, FACETS, and other software.
- Manages Provider Contracting service agreements internally and externally to improve coordination and accuracy of the deliverables. Coordinates problem resolution and implements tactics to improve processes with other departments as necessary.
- Manages assigned projects related to Provider Contracting related to rates, reimbursements, audits, or special requests.
- Performs basic financial analysis of contract proposals and financial and utilization data to determine medical cost impact.
- Provide financial analysis and review of SOAs, financial statements, settlements and retro cap/eligibility issues. Facilitates resolution of financial issues between provider and financial area of the corporation as necessary and appropriate.
- Negotiates settlements and audit recoveries.
- Drafts template contracts consistent with regulatory and legal requirements and HAP contracting strategy. Secures necessary approvals from HAP’s Legal Department and the State of Michigan Office of Financial and Insurance Services.
- Effectively communicates contract terms to Information Systems for configuration.
- Represents Provider Contracting in multi-departmental settings/projects and leads projects as assigned.
HAP Pay Grade: 24
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's Degree in Business or related field of study or at least six (6) years of related experience in lieu of education requirement.
- Master’s degree highly desirable.
- Minimum of two (2) years with health care plan.
- Minimum of three (3) years of experience with project management in a health care operations setting.
- At least two (2) years of experience with Plan or Provider finance or reimbursement, contract administration and operations, preferred.
- Knowledge Oracle, Facets, Cognos, NetworX, and related claims systems and similar software strongly preferred.
- Experience using workflow tool(s).
- Ability to initiate and coordinate multiple projects simultaneously.
- Understanding of legal and business principles in healthcare.
- Experience with regulatory authorities and Michigan Physician market preferred.
PHYSICAL DEMANDS/WORKING CONDITIONS:
- Position will require a flexible schedule with periodic evening/weekend work.
- Position requires travel with own car.
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.