Lead Provider Reimbursement Analyst - Health Alliance Plan
GENERAL SUMMARY:
Responsible for planning, organizing, directing, implementation and leading department assignments. Responsible for leading and delivering special projects and assignments related to contract negotiations with providers. Lead in development of financial models for several provider organizations, provider health organizations and hospital systems. Responsible for maintaining and updating financial models on a regular basis as new information and rates become available. Prepare and deliver presentation in a clear and concise manner to communicate findings from advanced analytics to management, provider groups and other stakeholders. Consult with business unit leaders and employees regarding implementation of initiatives and support decision making. Develop dashboards.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Utilize data analytics and extensive business knowledge to manage the research, analysis, identification and evaluation of data from identified problems to evaluate existing and potential trends, competition and issues.
- Possess and maintain in-depth knowledge of HAP business, products, programs (including claims reimbursement, benefits, provider and program data, networks etc) and complex research principles/ methodologies.
- Complete financial analysis for all contract negotiations which includes baseline data for all products, trending forward for future year impact, impact to network and associated medical loss ratios, analysis of best alternatives in the event of a contract termination.
- Assist in provider contract negotiation and administration, including annual updates to modify reimbursement rates and or methodologies for specific providers.
- Provide mentoring and guidance to other analysts. Ensures data integrity and reporting accuracy of the department. Helps facilitate healthcare knowledge development, and works to augment analysts’ technical skillset.
- Serve as subject matter expert and consultant to HAP’s senior leadership. Develop solutions to complex issues and present recommendations to senior management as well as employees at various corporate levels.
- Develop, implement and maintain Charge Change Control Management Data Analytics
- Complete financial analysis for multiple hospital systems, PHOs, POs, and large ancillary providers. Perform/Coordinate quarterly and annual fee schedule calculations.
- Provide reimbursement expertise, including but not limited to MS-DRGs methodology, APCs methodology, and fee schedule methodology. Facilitate resolution of financial issues between Provider Reimbursement and contracted Providers as necessary and appropriate.
- Participate in meetings with Providers to explain financial calculations and/or proposals and understand Provider counter-proposals.
- Act as liaison with other departments regarding Provider-related inquiries such as overpayments, settlements, SOAs and other financial issues arising in the Plan / Provider relationship.
- Act as a health care consultant by developing strategies and programs to reduce health care benefit costs and improve quality of care. Collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results.
- Demonstrate analytical, planning, problem solving, verbal and written skills to communicate complex ideas
- Other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Business Administration, Economics, Health Care, Finance, Information Systems, Statistics or related field.
- Minimum of five (5) years progressive analytical experience in a healthcare or managed care/insurance related setting with specific exposure to provider contracting and reimbursement data and methodologies as well as case management, disease management, patient/member data
- Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; predictive modeling and forecasting; key performance indicators as it relates to medical cost data.
- Demonstrated experience automating complex reporting processes and developing best practices and reporting standards.
- Extensive knowledge of advanced financial methods and modeling used in analyzing health care data and in data mining
- Excellent analytical, problem solving, verbal and written skills to communicate complex ideas.
- Excellent skills with ability to integrate and co relate information from different domains and subject areas.
- Minimum of three (3) years of experience in leading staff in projects or supervisory/management position preferred.
- Demonstrated project management experience in running corporate wide projects
- Knowledge of medical claims data and managed care membership data
- Knowledge of business intelligence applications, data, and tools
- Advanced technical skills, which includes, but is not limited to: MS Access and Excel, Alteryx, SQL, SAS and/or other statistical software.
- Knowledge of Medicare and Medicaid Reimbursement methodologies a plus.
- Intermediate to advanced Cognos Report Writer skills
- Ability to navigate HAP systems, including Oracle, Facets, and other similar software.
Overview
Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System 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
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. 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.