Managed Care Reimbursement/Hybrid Troy Position
4 weeks ago
This position is responsible for managing the payor contracting functions for the hospitals, medical centers, urgent care centers, and employed physicians of Henry Ford Health. The successful candidate will lead the Managed Care Contracting team in evaluating, analyzing, and negotiating contract terms and reimbursement rates with health plans.
Key Responsibilities:
• Lead payor negotiations and manage team that will 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 team in performing necessary analytics, with support from Contract Modeling team, 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 contracting team accountable for completing work accurately and timely, and keep Director informed on issues and progress.
• Maintain contracts, prioritize negotiations, and implement contracting strategy.
• Monitor marketplace for new contracting opportunities and make recommendations for changes 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.
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.
About Henry Ford Health System:
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 healthcare 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 https://www.henryford.com/.
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