Provider Contract Administrator; Hybrid - Troy, MI - Health Alliance Plan

Provider Contract Administrator (Hybrid - Troy, MI) - Health Alliance Plan

Responsible for provider contracting strategic initiatives that interface with all areas of thecompanyandaffectcontractualarrangementswithproviders;manageandmaintain operational and technical aspects of provider contracting; builds rates and reimbursement terms, manage configuration process for accurate reimbursement, maintain database related to reimbursement and rates, managed multiple projects simultaneously, and negotiates favorable contracts and builds integrity in contractual relationships within the scope of responsibility and subject matter expertise.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Manage rate configuration process for contractual relationships, including incentive and risk sharing models, with networks, IPAs, hospitals, hospital-based physician groups and other providers to manage costs and improve quality, service, and access.

Coordinates configuration for the contracting process by providing workflow documents, financial summaries, guiding principles, amendments, etc.

Acts as subject matter expert for provider contracting operations and technical areas using Contract Management Software, FACETS, and other software.

Manages Provider Contracting service agreements internally and externally to improve coordination and accuracy of the deliverables. Coordinates problem resolution and implements tactics to improve processes with other departments as necessary.

Manages assigned projects related to Provider Contracting related to rates, reimbursements, audits, or special requests.

Performs basic financial analysis of contract proposals and financial and utilization data to determine medical cost impact to HAP/PHP/AHLIC.

Provide financial analysis and review of SOAs, financial statements, settlements and retro cap/eligibility issues. Facilitates resolution of financial issues between provider and financial area of the corporation as necessary and appropriate.

Monitors financial, quality, service and access performance of assigned networks and providers, using HAP/PHP/AHLIC reports to ensure optimal performance.

Drafts template contracts consistent with regulatory and legal requirements and HAP contracting strategy. Secures necessary approvals from HAP’s Legal Department and the State of Michigan Office of Financial and Insurance Services.

Effectively communicates contract terms to Information Systems for configuration.

Represents Provider Contracting in multi-departmental settings/projects and leads projects as assigned.

Perform other related duties as assigned.

EDUCATION/EXPERIENCE

REQUIRED:

Bachelor's Degree in Business or related field of study or at least six (6) years of related experience in lieu of education requirement.

Minimum of three (3) years in health care.

Minimum of t wo (2) years of health care experience in plan or provider managed care which may include finance, reimbursement, contract administration, operations or related fields.

Experience with contracts and reimbursement methodologies for physician organizations, ancillary providers and/or physicians is preferred.

Knowledge and ability to navigate HAP systems, including Facets, Cactus/Symplr, preferred.

Experience d with Excel .

Ability to initiate and coordinate multiple projects simultaneously.

Understanding of legal and business principles in healthcare.

Position requires travel with own car.

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…