Michigan Great Lakes Job Bank

Insurance Contract Administrator / Managed Care Contracting
Henry Ford Health System

Posted 1/19/2024

Introduction:

Henry Ford Health provides 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. It is one of the nation’s leading academic medical centers, recognized for clinical excellence in cancer care, cardiology and cardiovascular surgery, neurology and neurosurgery, orthopedics and sports medicine, and multi-organ transplants. Consistently ranked among the top five NIH-funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of health professionals, Henry Ford Health trains more than 4,000 medical students, residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network. The health system is led by President and CEO Robert G. Riney and serves a growing number of customers across 250+ locations throughout Michigan including five acute care hospitals, two destination facilities for complex cancer and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers.

Job Summary:

Reporting to Director or Manager, assist in the development of Contract Strategy and work directly with Payors to lead negotiation of contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units.

Required Qualifications:

• Bachelor’s Degree in Business, Healthcare Administration, or Finance required.
• Five (5) years in the healthcare industry in a progressively more responsible professional capacity, with at least one (2) years of payor contracting, provider relations or provider reimbursement experience.
• Knowledge of managed care organizations and integrated health systems.
• Excellent oral and written communication and presentation skills.
• Excellent organizational skills and ability to manage multiple projects simultaneously.
• Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers.
• Strong negotiation skills.
• Understanding of legal, business, and insurance operations principles.
• Proficient in Microsoft Word and Excel.

Preferred Qualifications:

Master’s Degree.

Compensation/Benefits:

Based upon experience, education, and skill level. Salary range from $76,000 – 90,000

Instructions for Resume Submission:

Please apply directly to position: Insurance Contract Administrator – Full Time- Remote/Hybrid https://www.henryford.com/careers

Contracting – Reimbursement Consultant
Henry Ford Health System

Posted 1/19/2024

Introduction:

Henry Ford Health provides 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. It is one of the nation’s leading academic medical centers, recognized for clinical excellence in cancer care, cardiology and cardiovascular surgery, neurology and neurosurgery, orthopedics and sports medicine, and multi-organ transplants. Consistently ranked among the top five NIH-funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of health professionals, Henry Ford Health trains more than 4,000 medical students, residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network. The health system is led by President and CEO Robert G. Riney and serves a growing number of customers across 250+ locations throughout Michigan including five acute care hospitals, two destination facilities for complex cancer and orthopedics and sports medicine care, three behavioral health facilities, primary care and urgent care centers.

Job Description:

Under minimal supervision of the Manager, independently leads financial and data analysis to evaluate rate proposals, contract terms, and health plan network reimbursement. This position will proactively identify rates, methodologies, and processes that need improvement and will develop and implement solutions to optimize reimbursement for the health system.

Principal Duties and Responsibilities:

• Lead the development of financial reporting and analysis using software / tools such as EPSi, SQL, Epic, or Clarity to extract and analyze data for the purpose of assessing contracted rates and reimbursement methodologies
• Generate proactive analysis and make recommendations to Contracting leadership based on review and identification of payer reporting trends.
• Lead evaluation, and creation, of metrics and processes to improve and / or track rates against industry averages to identify gaps and areas for improvement.
• Manage the rate review process for existing and proposed contracts to evaluate financial impact, verify that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated.
• Coordinate with contract modeling team the implementation and maintenance of contract management/pricing systems.
• Maintain expertise in reimbursement methodologies, payer policies, and regulatory changes as they apply to payor contracts.
• Manage and complete special projects and attends various committee meetings as assigned.
• Coordinate and support financial projects for business units across the Health System

Required Qualifications:

Experience:

• 5 to 7 years of experience in healthcare finance, managed care contracting, or reimbursement in a professional capacity including experience with various reimbursement methodologies (DRGs, per diems, fee schedules, case rates, etc.)
• Report writing capabilities
• Strong Analytical and Critical Thinking skills (via curiosity, creativity, skepticism, and adept in use of logic) relative to accomplishing business objective and problem solving
• Detail oriented
• Proficient in Microsoft Excel (queries, reports, pivots, “What If” scenarios and database mgmt. a plus)
• Proficient in Data extraction & reporting tools (EPSi, SQL, Clarity, etc…)
• Excellent oral and written communication skills
• Strong organizational and interpersonal skills
• Strong Understanding of Managed Care Reimbursement methodologies, coding and terminology

Education Qualifications:

Bachelor’s Degree in Finance, Accounting, Business Administration, Managed Care Contracting, Reimbursement or related field. Master’s Degree Preferred.

Compensation/Benefits:

Based on experience, skill level, and education. Salary Range $98,000 – 118,000

Instructions for Resume Submission:

Please apply directly to the position:  “Managed Care Contract Reimbursement Consultant” at https://henryford.com/careers