What are the responsibilities and job description for the Manager Managed Care Contracting/Hybrid Troy position at Henry Ford Health - Careers?
GENERAL SUMMARY:
Reporting to the Director - Managed Care Contracting, 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. This position is responsible for leading the Managed Care Contracting team in evaluating, analyzing, and negotiating contract terms and reimbursement rates with health plans.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Lead payor negotiations and manage team that will evaluate and analyze contract proposals including reviewing/revising contract language and operational requirements.
2. Review contracts with in-house legal-council and work through contract revisions with Payors.
3. 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.
4. 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.
5. Implement and execute Managed Care Contracting Playbook initiatives.
6. Hold contracting team accountable for completing work accurately and timely. Keep Director informed on issues and progress.
7. Maintain contracts, prioritize negotiations, and implement contracting strategy.
8. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance Henry Ford Health contract portfolio.
9. 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.
10.Lead contracting functions to support Henry Ford Health joint ventures, strategic partnerships, new locations and services, and cross-departmental initiatives.
11.Lead team in coordination and implementation of Payor arrangements and provide ongoing education and support throughout Henry Ford Health.
12.Lead team in collection and communication relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Revenue Cycle, Legal, and other operational areas.
13.Ensure team maintains comprehensive files of Henry Ford Health contractual relationships and maintain contract information in the contract database.
14.Facilitate resolution of contracting and operational issues with payers, including billing, claim underpayments, utilization review, credentialing, notification of site closures or new services.
15.Maintain expertise in reimbursement methodologies and regulatory changes as they apply to payor contracts.
16.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.
17.Perform other duties and projects as assigned
EDUCATION/EXPERIENCE REQUIRED:
• Bachelor’s Degree in Business, Healthcare, Finance, Accounting, Healthcare Informatics, or related field required. Master’s Degree preferred.
• 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 oral, 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.
• Strong analytical skills with ability to collect, organize, analyze, and clearly present findings.
• 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.
