Manager - HAP Preferred Operations - Southfield
Requisition #: 75599
Status: Full-Time with Full-Time Benefits (40 Hours)
Business Unit: Health Alliance Plan (HAP)
Department: HAP PREFERRED OPERATIONS
Job Family: Billing
Job Function: Leadership/Management
Campus/Job Location Health Alliance Plan (HAP) Preferred
Location (State/City): US-MI-Southfield
The HPO Manager will plan, organize, manage, evaluate and coordinate the activities associated with the third party administrator (TPA)/Alliance Health and Life Claims Processing and Provider/Member Claim Appeals departments of HAP, including claims adjudication repricing, and reinsurance for HMO, TPA, and Insured products. They will develop and maintain functional relationships with Alliance Health and Life Company, external TPA, and related internal departments. They will support and administer corporate policies, procedures, and philosophies to promote quality customer service and control of expenses and indemnity objectives.
Principal Duties and Responsibilities:
- Provide overall direction and immediate supervision to the TPA/AHL Claims Processing and Provider/Member Claim Appeals through delegation of work assignments, projects, and tasks required to satisfy divisional and corporate goals, objectives, and strategies
- Develop, secure approval of, and implement policies, procedures, and protocols necessary to achieve short and long-term goals and objectives for HMO, Insurance Company, and TPA claim processing. Communicate and adhere to corporate policies and procedures; interpret and administer departmental objectives and quality standards consistent with guidelines established or affirmed by Corporate Management
- Interview, evaluate and select personnel for the department. Review the evaluations of employee performance and recommend appropriate coaching, training, developing, and corrective action for assigned departmental staff
- Oversee the development implementation of internal/external controls to ensure medical and administrative cost effectiveness, and compliance with quality service standards and objectives
- Monitor indemnity results and service quality to identify improvement opportunities; oversee technology vision and application for HMO, insurance, and TPA claims administration through corporate systems
- Coordinate necessary activities with Legal, medical Affairs, Membership, Marketing, Finance, and Information systems departments as appropriate for areas of joint interest or responsibility
- Develop, maintain, and ensure compliance with departmental and corporate budget guidelines
- Produce, analyze, monitor, and distribute departmental reports which identify key quality, productivity and service measures
- Maintain knowledge of current trends and developments in the field through the periodic review of books, journals and literature; attend related seminars, training sessions, and conferences as appropriate for continued education
· Bachelor's Degree in Business Administration, Finance, or Management
· Education specific to the Insurance Industry
· Licensed Insurance Agent or Third Party Administrator
· Four (4) years of related experience in medical claim administration, preferably with both a managed care and an indemnity environment
· Three (3) years of experience in a supervisory/lead capacity
· Two (2) years within a healthcare insurance environment
Skills and Abilities:
· Ability to plan, organize, develop, implement and evaluate activities and results as they relate to goals and objectives
· Problem solving, analytical and decision making
· Ability to cultivate and maintain interpersonal relationships in diversified settings with broad cross-section of people
· Oral and written communication skills
· Management skills
· Knowledge of insurance industry operations, health care benefits, structures, policies and procedures
· Technical understanding of data base oriented computer systems and applications
· Knowledge of economics, sociology, budgeting, and financial planning
· Knowledge and application of self-directed work teams
· Leadership - Listens and communicates effectively. (Be Here Now) Coaches and mentors others. Motivates and inspires others. Has the courage to innovate. Is accessible to others. Rewards and recognizes the accomplishments of others. Demonstrates self-awareness and self-management.
· Accountability for Results and Execution - Is accountable for achieving desired results. Demonstrates confidence in decisions and executes without undue delay. Leads by example (Shadow of a Leader). Demonstrates integrity and ethical behavior. Encourages and embraces diverse cultures, ideas and opinions.
· Strategic Planning - Aligns individual/department/business unit goals and tactics with System goals. Translates strategies into goals and action plans. Keeps team informed about the strategic direction of the organization and everyone's role in achieving that vision. Eliminates silos or boundaries that impede local and System-wide strategy development, action plan implementation, and goal achievement (Systems Thinking).
· Member/Customer Focus - Models strong personal service excellence skills creating a "Lasting Impression" for our members and customers. Develops service skills in others, and holds others accountable to uphold the HFHS "Team Member Standards of Behavior." Creates an environment that "puts patients first by providing the quality of care and comfort we want for our families and ourselves." Seeks out and uses data from members and other customers in developing world-class processes and in continuous improvement efforts in service excellence.
· Performance Analysis and Knowledge Management - Demonstrates competence and credibility in area(s) of responsibility (i.e., technical, professional, and, if appropriate, clinical proficiency). Understands and interprets performance reports from all pillars to drive decision-making; uses data to evaluate the potential risk and returns on investment. Actively seeks and incorporates feedback and best practices from others in order to learn and improve. Shares knowledge with others to drive organizational improvement.
· Staff Focus - Creates a stimulating, rewarding and engaging work environment for team members. Puts the right people in the right role (or assigns the right tasks) at the right time. Encourages and challenges staff to take risks and be innovative. Supports and encourages the development of others; facilitates their personal growth and offers assistance. Celebrates achievements, contributions, and accomplishments. Demonstrates honesty and consistency in communications with staff. Create a collaborative culture by demonstrating a positive attitude and hopeful energy.
· Process Management and Focus on Safety - Sets expectations and targets that are aligned with system goals in the areas of member safety and quality. Seeks and practices continuous improvement of products, services and processes. Is an agent of change (e.g., challenges the status quo; suggests alternative solutions to challenging problems, supports others with change). Creates an environment where people feel "safe" to speak up and speak out about safety issues and/or inappropriate behaviors. Follows guidelines of local and System-wide quality and safety initiatives, such as the No Harm campaign. Models and strictly enforces personal safe practices (e.g., hand-washing).
Physical Demands/Working Conditions:
· Typical office environment
· Sedentary – Exerts up to 10 lbs. of force occasionally to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for periods of time.
· Talking – Expressing or exchanging ideas by means of the spoken word.
· Hearing – Perceiving the nature of sounds
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, national origin, sex, sexual orientation, age, disability, religion, weight/height, marital status, familial status, veteran status or any other characteristic protected by law.
Henry Ford Health System - 21 months ago
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Built around a hospital founded by Detroit's favorite son, the not-for-profit Henry Ford Health System (HFHS) is a hospital network...