Responsible for developing next generation of hospital payment monitoring tools and processes (post PHA contract revisions) that allow for continuous review and detection of hospital payment issues that may conflict with existing hospital contracts, medical policy and payment policies.
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Oversee the design, development and implementation of an enhanced suite of tools designed to detect variances in hospital payments from BCBSM’s existing hospital contract terms, existing medical and payment policies.
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Support Hospital Contracting area’s work with hospitals as it relates to contract negotiations and evaluations, performance opportunities under value-based payment arrangements and other Hospital Contracting needs as they arise.
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Act as the primary liaison with key areas of the company to include Actuarial Services, Customer Reporting, and other business analytical areas embedded in the business segments of Senior Health Services (SHS), Health Plan Business (HPB) and Health Care Value (HCV).
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Ensure continued staff development, coaching and mentoring.
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Oversee the staff involved in hospital settlements and BCBSM Interim Payment (BIP) monitoring during the period where settlements will still be required.
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Oversee the transition of staff who are involved in the BIP, Hospital Settlement and Appeals.
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Develop and design next generation provider payment monitoring tools to flag potential areas of payment breaches and/or provider billing practices that may need to be investigated for potential recovery or other intervention strategies.
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Work with other data analytic areas of the Company to include Actuary, Customer Reporting, SHS Analytics and HCV Analytical areas in order to ensure consistency in data models and approaches to identifying customer opportunity.
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Provide routine analytical support to Provider Contracting.
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Ensure continued staff development, coaching and mentoring.
Qualifications
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Bachelor’s degree in Business Administration, Accounting or related field required. Master’s degree preferred.
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10 years of experience in hospital finance and revenue cycle processes required.
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5 years of experience in leading a data analytic team required.
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Excellent leadership, organizational, verbal and written communication skills.
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Strong analytical skills that include critical thinking, scientific inquisitiveness, complex modeling skills, and ability to analyze reports to isolate areas requiring further analyses.
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Ability to develop and lead teams, directly and indirectly.
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Strong understanding of SAS, Sequel, Tableau and other software tools that are used to query large databases and produce sophisticated reports.
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Ability to collaborate with multiple business areas.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
Job Provider Administration
Primary Location Detroit
Organization Provider Contracting Support-2129
Schedule Full-time
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