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

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 HAPs 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 HAPs 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:

• Bachelors degree in Health Care Administration, Business Administration or related field required.
• Masters 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 Information

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