Provider Contracting Assistant; Hybrid - Troy, MI - Health Alliance Plan

Coordinate processing and maintenance of provider contracts and maintenance of provider demographic information including new contracts, terminations and modifications, and configuration of Contract Manager, Facets or its successor systems. As a team member, provide administrative support, coordinate, and prepare appropriate correspondence/contracts/audits for regulatory agencies, network maintenance projects, and strategic initiatives.

DUTIES & RESPONSIBILITIES:

• Conduct activities to enroll providers for participation with HAP including pre-screening, preparing, and sending credentialing applications and contracts to providers, coordinating with delegated networks, and maintenance of tracking logs of all provider enrollments.
• Prepare contracts in the Contract Management System, send contracts to providers, and track contracts through approval process.
• Prepare Provider Reimbursement Worksheets (PRW’s) and or Ancillary Reimbursement Worksheets (ARWs) in accordance with departmental procedures for provider enrollments, terminations, demographic changes or other modifications.
• Assist department with all Single Case Agreements, regulatory reporting and audits, and special projects as needed.
• Resolve provider enrollment and provider inquiries in assigned Pega workbasket. Maintain caseload in Pega workbasket and email boxes on a regular basis.
• Assist department staff with telephone triage, field provider calls and direct as appropriate, assist internal departments with provider inquiries and reimbursement verification.
• Assist and participate in the interpretation, summarization, communication, and recommendation on key elements of provider contracts to the appropriate individuals both internal and external to the organization.
• Assist and participate in timely triage and resolution of provider issues.
• Assist and assume responsibility for focused projects within the department relating to provider contracting.
• Perform other related duties as assigned.

HAP Pay Grade: 18 (non-exempt)

Education/Experience Requirements:

• High School Diploma required.
• Two (2) years of college with courses in business, or computer related program preferred.
• Minimum of two (2) years of health care experience required.
• Minimum of two (2) years of Provider Relations/Provider Contracting experience.
• Strong working knowledge of computer systems and personal computers.
• Knowledge and experience of a managed care organization's operations are required.
• Knowledge of physician reimbursement methodologies is preferred.
• Analytical and problem-solving skills.
• Must possess organizational and time management skills.
• Self, motivated with effective communication and interpersonal skills.
• Knowledge of HAP's provider system preferred.
• Knowledge of Excel and Microsoft Word.

HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

Under the leadership of President and CEO Robert G. Riney, Henry Ford Health 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…