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Henry Ford Health System Manager - Managed Care Reimbursement - Detroit in Detroit, Michigan

GENERAL SUMMARY:

Manage and lead the Managed Care Reimbursement team that will evaluate, analyze and negotiate fee for service and value-based reimbursement contract terms, develop reimbursement model proposals and evaluate ongoing financial performance of HFHS payor contracts.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

  • Partnering with Contracting Manager, lead payor negotiations specific to reimbursement terms and value-based models for HFHS hospitals, physicians, ancillary services and clinically integrated networks. Perform necessary analytics with support from Contract Modeling team to evaluate and develop reimbursement rate proposals. Payors include direct to employer relationships and commercial, Medicare Advantage, Medicaid HMO, and other governmental payors.

  • Routinely monitor current contracts for appropriate reimbursement terms and renewals to ensure compliance with industry standards and HFHS reimbursement guidelines.

  • Review and analyze monthly financial trends and themes emerging from risk and value-based contracts to understand performance and assist in identifying necessary course correction.

  • Oversee monthly accounting process for risk sharing arrangements and financial analysis of value-based contracts.

  • Assist in development and revision of reimbursement and value based contracting guidelines and department policies/processes.

  • 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.

  • Ensure team maintains comprehensive files of HFHS reimbursement relationships including maintaining complete and accurate Rate Grids.

  • Maintain expertise in reimbursement methodologies and regulatory changes as they apply to payor contracts.

  • Provide System leadership and education in areas of expertise.

  • Perform other duties and projects as assigned.

EDUCATION/EXPERIENCE REQUIRED:

  • Bachelor’s Degree in Business, Finance, Accounting, Healthcare Informatics or related field required. Master’s Degree preferred.

  • Minimum of five (5) years of professional experience in progressively more responsible capacity with a minimum of two (2) years of healthcare, finance or related field required. Experience in reimbursement and/or data analytics 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.

  • Comprehensive project management abilities.

  • 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.

  • Proficient in Microsoft Word and Excel required, relational database experience preferred.

  • Strong analytical skills with ability to collect, organize, analyze and clearly present

    Overview

    Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health

    care systems, is a national leader in clinical care, research and education. The system includes

    the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health

    insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory

    network and many other health-related entities throughout southeast Michigan, providing a

    full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.

    The health system also is a major economic driver in Michigan and employs more than 24,600

    employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The

    health system is led by President and CEO Wright Lassiter III. To learn more, visitHenryFord.com.

    Benefits

    Whether it's offering a new medical option, helping you make healthier lifestyle choices or

    making the employee enrollment selection experience easier, it's all about choice. Henry

    Ford Health System has a new approach for its employee benefits program - My Choice

    Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

    dozens of options for all of our employees including compensation, benefits, work/life balance

    and learning - options that enhance your career and add value to your personal life. As an

    employee you are provided access to Retirement Programs, an Employee Assistance Program

    (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

    and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

    benefits and services. Employee's classified as contingent status are not eligible for benefits.

    Equal Employment Opportunity/Affirmative Action Employer

    Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System 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.
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