Manager - Provider Data Quality - Health Alliance Plan
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s Degree in Business Administration, Health Administration, Computer Science, Statistics or related field or Associates degree in Business Administration, Health Care Management or related field or equivalent experience of two (2) years job related experience in addition to two (2) years of experience leading projects and/or overseeing work teams not exclusive to direct report management experience.
- Three (3) years of progressive analytical experience in a healthcare or managed care/insurance related setting with specific exposure to one or more of the following: risk adjustment, claims, enrollment, reimbursement, networks, benefits, providers and program data required.
- Demonstrated knowledge and experience with Medicare Advantage (MA-PD) and HCR (Medicaid Optional) program operations and MCO plan payment methodology; established knowledge of MA and HCR Program data and CMS reports required.
- Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; predictive modeling and forecasting; key performance indicators required.
- Demonstrated project management experience required.
- One (1) year of managerial experience with direct reports preferred.
- Five (5) years of progressive analytical experience in a healthcare or managed care/insurance related setting with specific exposure to one or more of the following: risk adjustment, claims, enrollment, reimbursement, networks, benefits, providers and program data preferred.
- Nature of the work requires progressive interpersonal communication, decision making, financial and technical skills; ability to introduce new ideas, processes, measures and tools to improve healthcare performance.
- High energy; strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
- Demonstrated ability to function in a creative, "out-of-the-box" thinking in order to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
- Knowledge of business intelligence applications, data, and tools.
- Advanced technical skills which includes, but is not limited to, SQL, SAS, Cognos, MS Access and Excel skills.
- Knowledge of Medicare and Medicaid Reimbursement methodologies a plus.
- Comprehensive knowledge of electronic data processing required.
- Strong quantitative, analytical, and problem-solving skills.
- Excellent oral and written communication skills.
- Ability to organize and manage multiple priorities and/or projects by using appropriate methodologies and tools.
- Strong ability to work independently with limited direct supervision.
- Must be able to work with individuals of diverse background at a variety of levels.
- Ability to work with automated systems.
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.