Manager Managed Care Reimbursement/Hybrid Troy
GENERAL SUMMARY:
Reporting to the Director - Managed Care Contracting, this position is responsible for managing the payor contracting functions for the hospitals, medical centers, urgent care centers, and employed physicians of Henry Ford Health. This position is responsible for leading the Managed Care Contracting team in evaluating, analyzing, and negotiating contract terms and reimbursement rates with health plans.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Lead payor negotiations and manage team that will evaluate and analyze contract proposals including reviewing/revising contract language and operational requirements.
2. Review contracts with in-house legal-council and work through contract revisions with Payors.
3. Lead team in performing necessary analytics, with support from Contract Modeling team, to evaluate and develop reimbursement rate proposals for all payor relationships including direct to employer relationships and commercial, Medicare Advantage, Medicaid HMO, and other governmental payors.
4. Routinely evaluate current contracts for appropriate reimbursement terms and renewals to ensure compliance with industry standards and Henry Ford Health reimbursement guidelines and changes to cost structure.
5. Implement and execute Managed Care Contracting Playbook initiatives.
6. Hold contracting team accountable for completing work accurately and timely. Keep Director informed on issues and progress.
7. Maintain contracts, prioritize negotiations, and implement contracting strategy.
8. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance Henry Ford Health contract portfolio.
9. Review and analyze monthly financial trends and themes emerging from changes in cost structure, inflation, and risk to understand performance and assist in identifying necessary course correction.
10.Lead contracting functions to support Henry Ford Health joint ventures, strategic partnerships, new locations and services, and cross-departmental initiatives.
11.Lead team in coordination and implementation of Payor arrangements and provide ongoing education and support throughout Henry Ford Health.
12.Lead team in collection and communication relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Revenue Cycle, Legal, and other operational areas.
13.Ensure team maintains comprehensive files of Henry Ford Health contractual relationships and maintain contract information in the contract database.
14.Facilitate resolution of contracting and operational issues with payers, including billing, claim underpayments, utilization review, credentialing, notification of site closures or new services.
15.Maintain expertise in reimbursement methodologies and regulatory changes as they apply to payor contracts.
16.Perform all management functions for direct reports including holding team accountable for completing work accurately and timely, encouraging innovation and development, and completing performance reviews.
17.Perform other duties and projects as assigned
EDUCATION/EXPERIENCE REQUIRED:
• Bachelor’s Degree in Business, Healthcare, Finance, Accounting, Healthcare Informatics, or related field required. Master’s Degree preferred.
• Five (5) years in the healthcare industry, including at least two (2) years Payor contracting experience, provider relations, finance, or related field.
• Or in lieu of Bachelor’s degree, eight (8) years in the healthcare industry, including at least four (4) years Payor contracting experience, provider relations, finance, or related field.
• Experience in reimbursement and/or data analytics preferred.
• Knowledge of managed care organizations and integrated health systems.
• Comprehensive project management abilities.
• Excellent oral, 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.
• Strong analytical skills with ability to collect, organize, analyze, and clearly present findings.
• Understanding of legal, business, and insurance operations principles.
• Proficient in Microsoft Word and Excel. Relational database experience preferred.
• Must possess a strong understanding of reimbursement and value-based reimbursement models including risk share models based on total cost of care and bundle payments.
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.