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

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.
• 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 two (2) years in health care contracting
  
  

Or

• Minimum of three (3) years of healthcare experience in plan or provider managed care which may include finance, reimbursement, contract administration, operations or related fields.
• Experience with reimbursement methodologies for physician organizations, ancillary providers and/or physicians.
• Experienced with Excel.
• Ability to initiate and coordinate multiple projects simultaneously.
• Understanding of legal and business principles in healthcare.
• Knowledge and ability to navigate HAP systems, including Facets, Cactus/Symplr, preferred.
• Position will require flexible schedule with periodic evening/weekend work.
• Position requires travel with own car.
  
  

Additional Information

• Organization: HAP (Health Alliance Plan)
• Department: Provider Contracting
• Shift: Day Job
• Union Code: Not Applicable