Senior Provider Services Administrator (Hybrid/Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
The Senior Provider Service Administrator (SPSA) is the plan representative with key providers and PHO/PO groups who participate in value based and fee-for-service contracts with the health plan. The SPSA represents HAP at external forums and various healthcare and community wide coalitions; develops and maintains beneficial relationships with HAP’s provider community such as physicians, hospitals, ancillaries, and network PHO/PO administrators. The SPSA performs analysis, leads discussions with external and internal audiences, coordinates solutions within HAP’s internal departments including risk adjustment, quality, financial and health care management and executes solutions related to containment of medical costs. The SPSA administers value-based contract arrangements and programs with provider groups.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to contracted provider groups on improvement opportunities.
- Responsible for managing overall activities related to value-based contracts, including analyzing performance, developing strategy and approaches to help maximize performance potential.
- Monitors and advises provider performance to ensure achievement for financial and clinical targets and incentives. Implements strategies at a system level and within HAP, as directed by management.
- Presents identified provider performance opportunities to provider groups in Joint Operating Committee meetings and other forums.
- Works with Quality Management, Health Care Management, and Utilization Management, departments to ensure the provider relationships are enhanced with prompt and accurate resolutions.
- Generates and analyzes financial performance of assigned contracted groups to assist in the contracting process with existing and new providers.
- Facilitates educational interventions for assigned contracted groups related to financial and quality incentives.
- Supports provider contracting initiatives related to new products or network expansion to the provider community including implementation of value-based contract terms and programs.
- Represents the company in external large and small group forums by presenting company information relating to Provider Relations, including community wide coalitions.
- Represents Provider Relations in internal working committees related to assigned value- based contracted groups.
- Assumes responsibility for the overall relationship of assigned provider groups and escalates issues to leadership as appropriate.
- Perform additional duties as needed.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Health Care Administration, Business Administration or related field required.
- Master’s degree in Health Care Administration, Business Administration or related field preferred.
- Minimum of five (5) years relevant professional experience in Provider Relations and Contracting in managed care, pharmaceutical, or other health care setting required.
- Minimum of two (2) years interacting with clinical practices, including experience in analyzing and integrating financial and quality performance.
- At least two (2) years demonstrated experience in presentation and public speaking.
- Minimum of two (2) years training and development experience preferred.
- Ability to assess and foster positive relationships.
- Excellent interpersonal and relationship-building skills, including the ability to work with a diverse population.
- Excellent communication skills: written, verbal and listening.
- Strong problem-solving, decision making and analytical skills, with attention to detail.
- Ability to handle and prioritize multiple assignments using organization and time-management skills.
- Possess a high degree of tact, diplomacy, and empathy.
- Strong knowledge of Microsoft applications: Word, Power Point and Excel.
- Strong familiarity with the healthcare industry and various product offerings.
- Strong knowledge of provider contract language.
- Strong knowledge of provider risk arrangements.
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.