Provider Reimbursement Analys II - Health Alliance Plan - Troy

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Business (Non-Clinical)
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1810914 Requisition #
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GENERAL SUMMARY:


Responsible for planning, organizing, directing, implementation and leading department assignments. Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements. Demonstrate expertise in financial modeling and analysis. Responsible for completion of financial analysis related to contract negotiations with providers and the impact to HAP/HPI/AHLIC and projects specifically related to Health and Medical Management, Provider Contracting, and Information Services Departments. Involved in advanced analytics in support of conceptualization, design and evaluation of HAP healthcare expenditures, trends, provider reimbursements. Provide comprehensive quantitative as well as qualitative statistical analysis to support corporate wide strategic decision making as it relates to provider reimbursement initiatives. Prepare presentations and technical reports in a clear and concise manner to communicate findings from advanced analytics to management and other interested parties.


PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Provide mentoring and guidance to other analysts. Ensure data integrity and reporting accuracy of the department. Help facilitate healthcare knowledge development, and work to augment analysts’ technical skillset.
  • Conduct 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.
  • Conduct 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. Facilitates 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.
  • Work with Provider Contracting Management in communicating resolution of issues to senior management and various internal departments as necessary or appropriate.
  • 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.
  • Provide financial analytic support to Provider Contracting department and its entire staff.
  • Provide objective investigation and documentation of issues raised relative to financial management of various provider relationships.
  • Plan and manage projects, including requirements, design, construction, testing, acceptance, implementation and post-implementation review of project deliverables.
  • Lead complex initiatives to conclusion.
  • Other duties as assigned.



EDUCATION/EXPERIENCE REQUIRED:
  • Bachelor’s degree in Business Administration, Economics, Health Care, Finance, Information Systems, Statistics or other related field is required. Master’s degree in related field preferred
  • Minimum of three (3) 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
  • Minimum two (2) years of experience in relational databases such as Oracle and Access, ad hoc reporting tools, and analytical processing tools (Cognos Business Insight preferred).
  • 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.
  • 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 one (1) 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, 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

       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 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.

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