Lead Analyst, Vendor & Quality Compliance - Health Alliance Plan - Troy

📁
Clinical/Allied Health
📅
1911234 Requisition #

General Summary:


To plan, direct, evaluate and coordinate the activities managed within the Internal Quality Auditing department of Consumer Operations, as it relates to quality initiatives, business compliance monitoring, vendor monitoring and internal and external reporting.  To perform internal process and system control testing, auditing/monitoring (real-time and retrospective) of all vendor activities supporting the Consumer Operations division. . To assist in the execution of a departmental auditing plan that aligns with organizational goals and objectives and is in compliance with professional standards and assist with other compliance related activities.


Principal Duties and Responsibilities:

  • Provide daily direction, monitoring and oversight for the Quality Audit process across Consumer Operations, which includes the appropriate coaching and development, planning, staffing and coordination of activities as they pertain to divisional and corporate goals, strategies and objectives. 
  • Develop a comprehensive monthly monitoring program after identifying audit objectives, reviewing department's policy and procedure, flowcharting and initial evaluation of systems and controls.
  • Manage the processes of vendor sourcing, contract execution, budget planning, and vendor performance management. Establish standards and manage the process for vendor contract review and ongoing cost management. Assist in any changes or amendments to the original agreement; evaluates implications on current processes and lead the communication and implementation of changes as needed.
  • Develop and communicate a vendor roadmap, governance, strategy and metrics; present recommendations and results to help decisions makers understand the drivers of performance. Participate in end-to-end vendor procurement to ensure vendor management service level agreements are included in the RFI/RFP to final contracting process.
  • Audit vendor performance results and share vendor report card with appropriate management. Hold regularly scheduled calls with vendor to discuss Service Level Agreement and dashboard/report card results. Work with vendor to set goals and review during regular scheduled calls, agree to action plans and manage vendor to deliver agreed upon items. As issues are identified, work with vendor to identify root cause and corrective action plans to avoid a reoccurrence of the issue.
  • Perform regular end to end monitoring of compliance related processes to ensure that CMS Compliance is consistently being met. Monitor activities involving effective implementation of corrective action plan.
  • Develop and implement an on-going training plan for all resources handling inquiries and ensure staff is aware of changing regulatory requirements. Provide just-in-time training to staff based on real-time monitoring results
  • Develop and review department and corporate operational policies and procedures in accordance with DIFS, NCQA, DOL and CMS regulations and within departmental standards. Lead team to ensure workflow is continuous, performance standards are met and staff operates within the regulatory mandates such as CMS, NCQA, DIFS, DOL and HIPAA with respect to the various product lines.
  • Prepare all data for regulatory agency reviews (NCQA, CMS, DIFS and Medicare 5 Star).  Attend regulatory agency interview/audit meetings  to answer questions and explain monitoring processes to the various interviewers from these agencies.
  • Participate in Medicare Programs workgroups to ensure successful achievement of corporate objectives and regulatory compliance.  Participate in Medicare Program conference calls with CMS to ensure changes are understood and communicated effectively to appropriate staff.
  • Analyze call center data to identify impacting trends, perform root cause analyst and recommend customer service and process improvements.
  • Create and publish detailed reporting metrics for Leadership. Identify areas that require process improvement or staff training.
  • Work closely with HAP’s Compliance Department to ensure adequate controls are in place.
  • Develop skills and competencies of indirect reports to maximize employee engagement, increase productivity and create an environment of teamwork and commitment; coach and counsel people to exceed.  performance levels through professionalism, positive relations and timeliness in all customer contacts. 
  • Perform other related duties as assigned.

 

Education Required:

  • Bachelor’s or Master’s Degree in Health Care, Business or related field, preferred

Experience Required:

  • Minimum two (2) years of auditing experience; vendor management/monitoring experience preferred.
  • Minimum of four (4) years combined customer service and professional experience in health care, call center, business and/or insurance environment or capacity
  • Minimum of two (2) years of project coordination or project management and data analysis, validation and reporting
  • Demonstrated knowledge of CMS regulations and guidelines for Medicare products
  • Development of project status reports, workplans, timelines, budget reports, risk management, issue lists, and project metrics
  • Demonstrated experience with operational data interpretation, analysis, and reporting
  • Knowledge of key performance indicators related to health plan or health system performance (i.e. quality, cost/profitability, etc.)
  • Analytical experience in a health system or managed care/insurance related setting with specific exposure to member complaints data
  • Experience in providing written and verbal communications, including public presentations, to senior leadership


Preferred:

  • Certified in Health Care Compliance
  • Experience in consulting, market research/quantitative analysis, or healthcare administration working with and demonstrated knowledge of common industry reporting tools


 

     Overview

       Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health

       care systems, is a national leader in clinical care, research and education.  The system includes

       the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health

       insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory

       network and many other health-related entities throughout southeast Michigan, providing a

       full continuum of care.  In 2015, Henry Ford provided $299 million in uncompensated care.

       The health system also is a major economic driver in Michigan and employs more than 24,600

       employees.  Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient.  The

       health system is led by President and CEO Wright Lassiter III.  To learn more, 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.  Henry

       Ford Health System has a new approach for its employee benefits program - My Choice

       Rewards.  My Choice Rewards is a program as diverse as the people it serves.  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.  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 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.

Previous Job Searches

My Profile

Create and manage profiles for future opportunities.

Go to Profile

My Submissions

Track your opportunities.

My Submissions

Similar Listings

Troy, Michigan

📁 Clinical/Allied Health

Troy, Michigan

📁 Clinical/Allied Health

Troy, Michigan

📁 Clinical/Allied Health