Health Plan Contract Administrator (Hybrid in Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
Plan, lead and manage the day-to-day operation of the Compliance Program with respect to Government programs compliance requirements. Responsible, under the direction of the Director- Compliance, to provide overall strategic direction to manage compliance with Government programs rules and regulations. Serve as a subject matter expert and consultant to HAP’s Senior Leadership, Corporate Leadership Council members, members of various business areas, and Henry Ford Health Executives on key issues associated with compliance for Government programs.
Provide summary reports of compliance initiatives and monitoring metrics for Government programs compliance activities and report to the Corporate Compliance Committee. Act as the liaison for the Compliance department, collaborating with key departments and individuals such as Human Resources, Membership & Billing, Sales, Client Services, Legal, I.T. and the Information Security Officer to ensure policies and procedures are designed, developed, and implemented to ensure compliance with Government programs regulations.
Manage investigative activities related to Government programs compliance issues and violations including coordinating with business units and departments to monitor and assess violations, ensure timely investigations and corrective actions as well as tracking of violations for the purpose of annual reporting.
NOTE: Government programs compliance oversight and regulations may be specific to Medicare, Medicaid, Office of Personnel Management (OPM) the Affordable Care Act (ACA) or the Health Insurance Portability and Accountability Act (HIPAA).
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Implement initiatives to raise awareness of Government programs compliance including Lead, plan, develop and conduct education and training activities related to compliance; Develop presentations for departments and individuals at all levels to provide compliance regulatory updates; Provide regular contributions to the compliance newsletter.
- Develop and/or revise policies, procedures, documents, forms, tools, job aids and training and awareness materials both organization wide and business area specific in accordance with Government programs regulations and obtain corporate approvals as necessary.
- Conduct annual risk assessment for Government programs compliance and create and execute an annual compliance auditing plan, including identifying and overseeing resolution of any management corrective action activities.
- Manage ongoing compliance monitoring and auditing and provide recommendations for corrective actions to the business areas.
- Manage relationship with government regulators at the state and national level for Government programs compliance and investigate and respond to all government agency inquiries and investigations.
- Identify and supply on a regular basis relevant metrics, compliance risk indicators and provide reports on Government programs compliance issues affecting key program initiatives.
- Review legal policy and regulations related to Government programs, translate those regulations into business and technology requirements, then provide consultative opinions, and facilitate compliance by working with various business areas and other stakeholders to lead multiple implementation efforts.
- Serve as subject matter expert to a variety of system-level initiatives (e.g., product development efforts, new sales channel implementations, provider initiatives, information technology advancements etc.) and ensure these key initiatives are taken from development to fruition in a compliant manner including recommending enhancements.
- Facilitate and manage compliance committees and workgroups with participants from across the organization supporting Government programs compliance.
- Oversee the intake, documentation, investigation, analysis and remediation of compliance violations and issues for Government programs compliance, including escalation to leadership and senior leadership as appropriate.
- Perform other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Business Administration, Health Administration, Public Health/Public Policy, Public Planning, Law, or other degree with relevant work experience in the healthcare industry.
- Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of academic requirements. Related experience is defined as six (6) years of experience in compliance or insurance/health plan industry.
- Master’s degree preferred.
- Three (3) years of experience in insurance/health plan industry, including:
- Experience in health plan compliance.
- Experience with ACA, Medicare Advantage Part D and Medicaid compliance regulations.
- Certification or designation in Health care compliance or Managed Care a plus.
- Working knowledge of corporate compliance policies.
- Two (2) years of experience in project management/coordination and ability to implement corporate-wide projects and initiatives of a highly complex nature.
- One (1) year of experience in leading staff in projects or supervisory/management position preferred.
- Prior compliance issue investigation and/or compliance or internal auditing experience.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.