Provider Operations Service Representative (Hybrid/Troy, MI) - Health Alliance Plan
GENERAL SUMMARY:
The role will serve as primary contact for providers for education and training with HAP operations. PSA will develop positive and supportive relationships with affiliated providers, to include physician/hospital organizations, primary care physicians, specialty care physicians and ancillary providers. PSA will improve provider compliance with HAP policies and procedures while providing support to providers and assist them in becoming HAP advocates by improving practice operations, productivity, patient satisfaction, and performance improvement in the areas of quality, utilization, and risk adjustment.
DUTIES AND RESPONSIBILITIES:
Conduct telephonic and in-person educational sessions and physician office staff orientations with providers (physicians, office staff, hospital staff, ancillary providers, and hospital/network administrators).
Educate providers about HAP programs and operations including:
HAP products and lines of business
Claims, referral, and eligibility verification processes
Referral/authorization guidelines and system training
HAP provider portal training
Performance improvement opportunities in the areas of quality, utilization, risk adjustment, and cost
Regulatory standards required by CMS, NCQA, MDHHS, etc.
Disease and medical management programs
Utilization management guidelines
HAP and network policies and procedures including updates
Contracting and credentialing processes
Assist in the development, implementation and communication of policies and procedures required by HAP, NCQA, CMS, and MDHHS to ensure quality health care and efficient managed care operations in a provider setting.
Assist providers with interpretation of HAP’s provider data reports. Help providers to obtain additional reports to support utilization and/or medical management, as needed.
Serve as an ombudsperson for providers, offering to resolve challenges or concerns at the provider site, or by communicating problems to the appropriate HAP staff.
Develop and communicate an understanding of financial performance issues, provider profiling, and other related matters that impact provider behaviors.
Develop and communicate an understanding of HAP Medical Management functions and processes, including management of utilization, quality, and care.
Develop and maintain effective relationships with network administrators.
Assist in the coordination and presentation of provider conferences, workshops, and orientations.
Represent Provider Network Management department in internal workgroups.
Represent Provider Network Management department and HAP in network joint operating committee meetings; collaborate with Senior Provider Service Administrators to facilitate, prepare materials, and follow-ups for joint operating committee meetings.
May require significant travel within Michigan.
EDUCATION/EXPERIENCE REQUIREMENTS:
Bachelor’s degree in Health Care Administration, Business or related field required or an additional two (2) years of experience with provider issue resolution; may be considered in lieu of education requirement.
Minimum of three (3) years’ experience in a health care or health insurance setting.
Minimum of two (2) years’ experience in provider relations or education, communication, and issue resolution; and communication of financial and utilization information in a health insurance setting.
Previous presentation and public speaking experience.
Strong knowledge of Health Insurance products and product lines preferred.
Excellent verbal communication and interpersonal skills, including the ability to communicate effectively with clinical personnel.
Strong interpersonal and relationship building skills, including the ability to work effectively with diverse groups.
Problem-solving ability and attention to detail.
Strong organizational and time management skills.
Ability to prioritize and manage multiple tasks simultaneously.
Support corporate objectives and focus on long term goals.
Ability to think strategically and apply system thinking to provider relations.
Strong presentation and public speaking skills.
Demonstrated business-writing skills.
Self-starter.
Strong decision-making skills.
Working knowledge of Internet-based applications.
Working knowledge of communication and contact tracking programs
Working knowledge of Word, Excel, and PowerPoint
Must possess and maintain (1) a valid driver's license and (2) a driving record that meets the criteria specified through Henry Ford Health Systems' Corporate Insurance Program.
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.