Healthcare Reimbursement Manager

3 days ago

Troy, Michigan, United States Henry Ford Health System Full time
Job Summary

We are seeking a highly skilled and experienced Healthcare Reimbursement Manager to join our team at Henry Ford Health System. This is a critical role that requires strong leadership and negotiation skills, as well as a deep understanding of healthcare reimbursement and analytics.

Key Responsibilities
  • Lead payor negotiations and manage a team to evaluate and analyze contract proposals, including reviewing and revising contract language and operational requirements.
  • Review contracts with in-house legal counsel and work through contract revisions with payors.
  • Lead a team in performing necessary analytics to evaluate and develop reimbursement rate proposals for all payor relationships, including direct to employer relationships and commercial, Medicare Advantage, Medicaid HMO, and other governmental payors.
  • Routinely evaluate current contracts for appropriate reimbursement terms and renewals to ensure compliance with industry standards and Henry Ford Health reimbursement guidelines and changes to cost structure.
  • Implement and execute Managed Care Contracting Playbook initiatives.
  • Hold the contracting team accountable for completing work accurately and timely, and keep the Director informed on issues and progress.
  • Maintain contracts, prioritize negotiations, and implement contracting strategy.
  • Monitor the marketplace for new contracting opportunities and make recommendations to enhance Henry Ford Health contract portfolio.
  • Review and analyze monthly financial trends and themes emerging from changes in cost structure, inflation, and risk to understand performance and assist in identifying necessary course correction.
  • Lead contracting functions to support Henry Ford Health joint ventures, strategic partnerships, new locations and services, and cross-departmental initiatives.
  • Lead the team in coordination and implementation of Payor arrangements and provide ongoing education and support throughout Henry Ford Health.
  • Lead the team in collection and communication of relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Revenue Cycle, Legal, and other operational areas.
  • Ensure the team maintains comprehensive files of Henry Ford Health contractual relationships and maintains contract information in the contract database.
  • Facilitate resolution of contracting and operational issues with payers, including billing, claim underpayments, utilization review, credentialing, notification of site closures or new services.
  • Maintain expertise in reimbursement methodologies and regulatory changes as they apply to payor contracts.
  • Perform all management functions for direct reports, including holding the team accountable for completing work accurately and timely, encouraging innovation and development, and completing performance reviews.
  • Perform other duties and projects as assigned.
Requirements
  • Bachelor's Degree in Business, Healthcare, Finance, Accounting, Healthcare Informatics, or related field required. Master's Degree preferred.
  • Five (5) years in the healthcare industry, including at least two (2) years Payor contracting experience, provider relations, finance, or related field.
  • Or in lieu of Bachelor's degree, eight (8) years in the healthcare industry, including at least four (4) years Payor contracting experience, provider relations, finance, or related field.
  • Experience in reimbursement and/or data analytics preferred.
  • Knowledge of managed care organizations and integrated health systems.
  • Comprehensive project management abilities.
  • Excellent oral, written communication and presentation skills.
  • Excellent organizational skills and ability to manage multiple projects simultaneously.
  • Excellent interpersonal skills and ability to develop effective working relationships with both internal and external customers.
  • Strong negotiation skills.
  • Strong analytical skills with ability to collect, organize, analyze, and clearly present findings.
  • Understanding of legal, business, and insurance operations principles.
  • Proficient in Microsoft Word and Excel. Relational database experience preferred.
  • Must possess a strong understanding of reimbursement and value-based reimbursement models including risk share models based on total cost of care and bundle payments.

  • Healthcare Reimbursement Manager

    1 day ago

    Troy, Michigan, United States Henry Ford Health System Full time

    Job SummaryWe are seeking a highly skilled Healthcare Reimbursement Manager to join our team at Henry Ford Health System. This is a critical role that requires a strong understanding of healthcare reimbursement and contracting principles.Key ResponsibilitiesLead payor negotiations and manage team to evaluate and analyze contract proposals.Review contracts...

  • Healthcare Reimbursement Manager

    3 weeks ago

    Troy, Michigan, United States Henry Ford Health System Full time

    Job SummaryWe are seeking a highly skilled Healthcare Reimbursement Manager to join our team at Henry Ford Health System. As a key member of our Managed Care Contracting team, you will be responsible for leading the evaluation, analysis, and negotiation of contract terms and reimbursement rates with health plans.Key ResponsibilitiesLead Payor Negotiations:...

  • Travel Physical Therapist

    4 weeks ago

    Troy, Michigan, United States GO HEALTHCARE, INC. Full time

    Job Title: Travel Physical TherapistGo Healthcare is seeking a skilled Physical Therapist for a travel job in Ohio.Job Details:Specialty: Physical TherapistDiscipline: TherapyDuration: 12 weeksHours: 40 hours per weekShift: 8 hours, daysEmployment Type: TravelAs a travel Physical Therapist with Go Healthcare, you will have the opportunity to work with a...

  • Healthcare Operations Director

    3 weeks ago

    Troy, Michigan, United States Rehmann Full time

    Job OpportunityWe are seeking a highly skilled and experienced Healthcare Operations Manager to join our team at Rehmann. The successful candidate will be responsible for managing and coordinating business, financial, and administrative work to ensure excellence in customer service and office operations.Key ResponsibilitiesAssist with business planning and...

  • Travel Physical Therapist

    1 month ago

    Troy, Michigan, United States LRS Healthcare - Lab Full time

    Job Title: Travel Physical TherapistLRS Healthcare - Lab is seeking a skilled Physical Therapist for a travel job in Troy, Ohio.Job Details:Specialty: Physical TherapistDiscipline: TherapyDuration: 13 weeksHours: 40 hours per weekShift: 8 hours, daysEmployment Type: TravelBenefits:Medical, Dental, and VisionShort-Term DisabilityLong-Term DisabilityLife...

  • Healthcare Access Representative

    1 month ago

    Troy, Michigan, United States Mercy Full time

    Job SummaryThe Patient Access Representative is a critical role in the healthcare industry, serving as the first point of contact for patients and their families. As a representative of Mercy, this individual must embody the highest standards of customer service, compassion, and professionalism.Key ResponsibilitiesFacilitate the patient's entrance into any...

  • Healthcare Professional

    1 hour ago

    Troy, Michigan, United States TROY MANOR, L.L.C. Full time

    Job Summary: We are seeking a skilled Nurse to join our team at Troy Manor, L.L.C. as a Licensed Practical Nurse or Registered Nurse. The ideal candidate will have a strong work ethic and be able to work a variety of shifts, including night shifts and weekends.Responsibilities:* Provide high-quality patient care in a fast-paced environment* Collaborate with...

  • Provider Relations Manager

    3 days ago

    Troy, Michigan, United States Molina Healthcare Full time

    Job SummaryMolina Healthcare is seeking a skilled Provider Relations Manager to join our team. This role is responsible for developing and maintaining strong relationships with healthcare providers, ensuring network adequacy and provider satisfaction.Key Responsibilities:Develop and implement network development strategies to ensure network adequacy and...

  • Director, Healthcare Services

    3 days ago

    Troy, Michigan, United States Alvarez & Marsal Full time

    Job Title: Director, Healthcare ServicesAlvarez & Marsal (A&M) is a leading global professional services firm that provides turnaround management, restructuring, performance improvement, and corporate advisory services. Our Healthcare Industry Group (HIG) is a renowned leader in delivering tangible results for healthcare c-suite executives, boards, private...

  • Facilities Manager

    4 days ago

    Troy, Michigan, United States Graham Healthcare Group Full time

    Job TitleFacility ManagerJob SummaryGraham Healthcare Group is seeking a skilled Facility Manager to oversee the maintenance and repair of company buildings, properties, and equipment. The ideal candidate will have a strong background in property management and maintenance, with experience working with multi-location/multi-state organizations.Key...

  • Nuclear Medicine Technologist

    1 month ago

    Troy, Michigan, United States Health Carousel - Travel Allied Full time

    Health Carousel - Travel Allied is seeking a skilled Nuclear Medicine Technologist for a travel assignment in a dynamic healthcare setting.**Job Details:*** Specialty: Nuclear Medicine Technologist* Discipline: Allied Health Professional* Employment Type: Travel* Shift: 8 hours, days* Duration: 13 weeks* Hours per week: 40**About the Role:**As a Nuclear...

  • Healthcare Support Specialist

    3 days ago

    Troy, Michigan, United States UnitedHealth Group Full time

    Job SummaryWe are seeking a skilled Patient Care Coordinator to join our team at UnitedHealth Group. As a key member of our front office team, you will play a vital role in providing exceptional patient care and support.Key Responsibilities:Provide reception and clerical support to patients and callersSchedule appointments and manage patient schedulesAssist...

  • Healthcare Compliance Attorney

    4 days ago

    Troy, Michigan, United States gpac Full time

    Job Title: Healthcare Compliance AttorneyWe are seeking a highly skilled and experienced Healthcare Compliance Attorney to join our dynamic legal team. The ideal candidate will have a strong background in healthcare compliance, excellent research and writing skills, and a deep understanding of the legal process.Key Responsibilities:Develop and implement...

  • Facilities Operations Manager

    3 weeks ago

    Troy, Michigan, United States Graham Healthcare Group Full time

    Facility Manager Job DescriptionGraham Healthcare Group is seeking a skilled Facility Manager to oversee the maintenance and repair of our company buildings, properties, and equipment. This role requires strong communication and organizational skills, as well as the ability to work independently and as part of a team.Key Responsibilities:Execute new facility...

  • Facility Operations Manager

    3 days ago

    Troy, Michigan, United States Graham Healthcare Group Full time

    Facility Manager Job DescriptionGraham Healthcare Group is seeking a skilled Facility Manager to oversee the maintenance and repair of company buildings, properties, and equipment. The ideal candidate will work closely with the Director of Facilities and building management to ensure compliance with regulations and ordinances.Key Responsibilities:Execute new...

  • Healthcare Data Analyst

    3 days ago

    Troy, Michigan, United States Henry Ford Health System Full time

    Job Summary:The Healthcare Data Analyst will provide comprehensive quantitative and qualitative analysis to support corporate-wide strategic decision making as it relates to medical cost savings initiatives.Key Responsibilities:Leverage data analytics techniques to drive insights from data.Perform analyses related to medical cost-saving initiatives, key...

  • Facility Operations Manager

    4 weeks ago

    Troy, Michigan, United States Graham Healthcare Group Full time

    Facility Manager Job DescriptionGraham Healthcare Group is seeking a skilled Facility Manager to oversee the maintenance and repair of our company buildings, properties, and equipment. This role requires a strong background in property management and maintenance, with excellent communication and organizational skills.Key Responsibilities:Execute new facility...

  • Facility Operations Manager

    4 weeks ago

    Troy, Michigan, United States Graham Healthcare Group Full time

    Facility ManagerGraham Healthcare Group is seeking a skilled professional to oversee the maintenance and repair of all company buildings, properties, and equipment. As a key member of our facilities department, you will work closely with our Director of Facilities and building management to ensure compliance with standard regulations and ordinances.Key...

  • Healthcare IT Internship Opportunity

    4 hours ago

    Troy, Michigan, United States Henry Ford Health System Full time

    Healthcare IT Internship OpportunityWe are seeking a motivated and talented individual to join our IT team as an intern for the Summer 2025 Intern Program.The full-time program will run from May 12 to August 8, with the opportunity to start part-time sooner.This paid internship will require the ability to work in-person at the HAP building in Troy,...

  • Unit Manager-LPN or RN Troy

    3 weeks ago

    Troy, Michigan, United States Optalis Healthcare Full time

    Job SummaryThe Unit Manager plays a crucial role in overseeing the care management of patients within an assigned area, unit, or clinical function. This position conducts the nursing process, including assessment, planning, implementation, and evaluation, under the scope of the State's Nurse Practice Act for Registered Nurse or Licensed Practical Nurse...