Healthcare Contracting Manager

4 weeks ago


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

Job Summary:

The Healthcare Contracting Manager will lead the Managed Care Contracting team in evaluating, analyzing, and negotiating contract terms and reimbursement rates with health plans. 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.

Key Responsibilities:

  • Lead payor negotiations and manage team that will evaluate and analyze contract proposals including reviewing/revising contract language and operational requirements.
  • Review contracts with in-house legal-council 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.
  • Monitor marketplace for new contracting opportunities and make recommendations of 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.
  • Lead contracting functions to support Henry Ford Health joint ventures, strategic partnerships, new locations and services, and cross-departmental initiatives.
  • Lead team in coordination and implementation of Payor arrangements and provide ongoing education and support throughout Henry Ford Health.
  • Ensure team maintains comprehensive files of Henry Ford Health contractual relationships and maintain 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 team accountable for completing work accurately and timely, encouraging innovation and development, and completing performance reviews.

Requirements:

  • Bachelor's Degree in Business, Healthcare, Finance, Accounting, Healthcare Informatics, or related field required.
  • 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 organizational skills and ability to manage multiple projects simultaneously.
  • 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:

Henry Ford Health is a leading academic medical center and one of the nation's most respected healthcare systems. 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 health care retail.

We are 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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