Insurance Contract Consultant/Full Time/Hybrid
Reporting to Director or Manager, assist in the development of Contract Strategy and work directly with Payors to lead negotiation of contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units.
1. Independently evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Review contracts with in house legal-council and work through contract revisions with Payors.
2. Assist in developing Value Based contracting guidelines and take lead role in negotiating Value Based contract models and other complex payor relationships.
3. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines.
4. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance HFHS contract portfolio.
5. Coordinate implementation of Payor arrangements and provide ongoing education and support throughout HFHS.
6. Collect and communicate relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc.
7. Maintain comprehensive files of HFHS contractual relationships and maintain contract information in the contract database.
8. Act as liaison between HFHS and Payors and facilitate resolution of contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services.
9. Assist in the development and revision of department policies and processes.
10.Provide guidance and assist other Contract Administrators.
11.Provide System leadership and education in area(s) of expertise.
12.Perform other duties and projects as assigned
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's Degree in Business, Healthcare or related field required.
- Five (5) years in the healthcare industry in a progressively more responsible professional capacity, with at least one (1) year of payor contracting, provider relations or provider reimbursement experience.
- Knowledge of managed care organizations and integrated health systems.
- Comprehensive project management abilities.
- Excellent oral and written communication and presentation skills.
- Excellent organizational skills and ability to manage multiple projects simultaneously.
- Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers.
- Strong negotiation skills. Understanding of legal, business, and insurance operations principles.
- Proficient in Microsoft Word and Excel.
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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.