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GENERAL SUMMARY:

Responsible for provider contracting strategic initiatives that interface with all areas of the company and affect contractual arrangements with providers; manage and maintain 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.

+ Negotiates settlements and audit recoveries.

+ 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.

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.

+ Master’s degree desirable.

+ Minimum of two (2) years with health care plan.

+ Minimum of three (3) years of experience with project management in a health care operations setting.

+ At least two (2) years of experience with Plan or Provider finance or reimbursement, contract administration and operations, preferred.

+ Knowledge and ability to navigate HAP systems, including Oracle, Facets, Cognos, NetworX, and related claims systems and similar software strongly preferred.

+ Experience using workflow tools.

+ Ability to initiate and coordinate multiple projects simultaneously.

+ Understanding of legal and business principles in healthcare.

Additional Information

+ Organization: HAP (Health Alliance Plan)

+ Department: Provider Contracting

+ Henry Ford Health Location: HAP (Health Alliance Plan)

+ Shift: Day Job

+ Union Code: Not Applicable

Additional Details

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

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 health care 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 henryford.com/careers .

Benefits

The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is

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.