Senior Provider Services Administrator (Hybrid/Troy, MI) - Health Alliance Plan

Senior Provider Services Administrator (Hybrid/Troy, MI) - Health Alliance Plan Henry Ford Health - 3.8 Troy, MI Job Details 1 day ago Benefits Health insurance Dental insurance Tuition reimbursement Qualifications Contract management Microsoft Excel Contract management in healthcare Financial analysis Bachelor's degree Decision making Data interpretation Contracts Presentation creation Productivity software Stakeholder relationship building Full Job Description

GENERAL SUMMARY

The Senior Provider Service Administrator (SPSA) is the plan representative with key providers and PHO/PO groups who participate in value based and fee-for-service contracts with the health plan. The SPSA represents HAP at external forums and various healthcare and community wide coalitions; develops and maintains beneficial relationships with HAP's provider community such as physicians, hospitals, ancillaries, and network PHO/PO administrators. The SPSA performs analysis, leads discussions with external and internal audiences, coordinates solutions within HAP's internal departments including risk adjustment, quality, financial and health care management and executes solutions related to containment of medical costs. The SPSA administers value-based contract arrangements and programs with provider groups.

PRINCIPLE DUTIES AND RESPONSIBILITIES

Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to contracted provider groups on improvement opportunities. Responsible for managing overall activities related to value-based contracts, including analyzing performance, developing strategy and approaches to help maximize performance potential. Monitors and advises provider performance to ensure achievement for financial and clinical targets and incentives. Implements strategies at a system level and within HAP, as directed by management. Presents identified provider performance opportunities to provider groups in Joint Operating Committee meetings and other forums. Works with Quality Management, Health Care Management, and Utilization Management, departments to ensure the provider relationships are enhanced with prompt and accurate resolutions. Generates and analyzes financial performance of assigned contracted groups to assist in the contracting process with existing and new providers. Facilitates educational interventions for assigned contracted groups related to financial and quality incentives. Supports provider contracting initiatives related to new products or network expansion to the provider community including implementation of value-based contract terms and programs. Represents the company in external large and small group forums by presenting company information relating to Provider Relations, including community wide coalitions. Represents Provider Relations in internal working committees related to assigned value- based contracted groups. Assumes responsibility for the overall relationship of assigned provider groups and escalates issues to leadership as appropriate. Perform additional duties as needed.

EDUCATION/EXPERIENCE REQUIRED

Bachelor's degree in Health Care Administration, Business Administration or related field required. Master's degree in Health Care Administration, Business Administration or related field preferred. Minimum of five (5) years relevant professional experience in Provider Relations and Contracting in managed care, pharmaceutical, or other health care setting required. Minimum of two (2) years interacting with clinical practices, including experience in analyzing and integrating financial and quality performance. At least two (2) years demonstrated experience in presentation and public speaking. Minimum of two (2) years training and development experience preferred. Ability to assess and foster positive relationships. Excellent interpersonal and relationship-building skills, including the ability to work with a diverse population.

Excellent communication skills:

written, verbal and listening. Strong problem-solving, decision making and analytical skills, with attention to detail. Ability to handle and prioritize multiple assignments using organization and time-management skills. Possess a high degree of tact, diplomacy, and empathy.

Strong knowledge of Microsoft applications:

Word, Power Point and Excel. Strong familiarity with the healthcare industry and various product offerings. Strong knowledge of provider contract language. Strong knowledge of provider risk arrangements. 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.