Job Description

Admin Specialist Inter Health

The Managed Care Contracting and Operations (MCCO) Department is responsible for the negotiation, implementation, administration, and operations of managed care agreements on behalf of Michigan Medicine, UMH-Sparrow, and UMH-West with all payers. MCCO also is responsible for Pre-Service Single Case Agreements, which are patient specific most often involving Out of State Payers. The Managed Care Payer Analyst will report to the Manager, Managed Care Operations and will assist in supporting the department with the day-to-day operations of all payer contracts for all three health systems, which includes: Joint Operating Committee (JOC) Meetings with Payers, Payer Oversight Committee Meetings, oversight of MCCO departmental mailbox, etc. The Managed Care Payer Analyst plays a vital role in ensuring transparent, effective communications, problem resolution, and relationship oversight exists between the MCCO Department and Payers.

The Managed Care and Contracting Office is responsible for the negotiation, implementation, and administration of managed care agreements between Michigan Medicine, UM Health-Sparrow and UM Health-West and a wide range of healthcare delivery options. The Managed Care Payer Analyst will report to the Manager, Managed Care Operations, and will support the department by assisting in the responsibilities of JOCs, Payer Oversight Committee Meetings and other operational duties as they relate to Payer relationships. Provide backup as necessary for other MCCO Department responsibilities.

Michigan Medicine improves the health of patients, populations, and communities through excellence in education, patient care, community service, research, and technology development, and through leadership activities in Michigan, nationally, and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education, and research that together enhance our contribution to society.

Responsibilities:

• Analyze and improve operational processes related to managed care for all three sites including Michigan Medicine, Sparrow Health System, and UMHWest.
• Collect, analyze, and interpret data related to managed care programs, including reimbursement rates, claims data, and provider performance metrics.
• Collect and maintain information related to payers and plan relations, including the Payer and Plan Grid, Payer Profiles and Report Cards
• Oversee the tracking, follow-up, and resolution of action items resulting from various payer meetings, including Joint Operating Committee (JOC) meetings, ensuring timely execution and alignment with organizational objectives.
• Provide strategic support to the Managed Care Contracting and Operations team by coordinating and contributing to internal initiatives, including the Revenue Cycle Forum, with a focus on integration and alignment across all three health systems.
• Partner with the Manager of Managed Care Operations and the Senior Director of Managed Care Contracting and Operations to plan, coordinate, and support Joint Operating Committee (JOC) meetings with payers across Michigan Medicine, UMH-Sparrow, and UMH-West, ensuring alignment with organizational priorities and contractual obligations.
• Engage in Payer Oversight Committee meetings to evaluate and address escalated payer issues submitted through the SBAR process, serving as a strategic review point for determining the appropriateness of advancing concerns to Joint Operating Committees (JOCs)
• Responsible for creation, dissemination, maintenance, and tracking action items toward resolution of various payer meeting minutes, including but not limited to Joint Operating Committee meetings (JOCs).
• Create, distribute, maintain, and track various payer meeting agendas, including but not limited to Joint Operating Committee meetings (JOCs).
• Responsible for tracking and following up on action items from various payer meetings, including but not limited to Joint Operating Committee meetings (JOCs), and reporting progress status.
• Assist and represent the Managed Care Contracting and Operations team with internal meetings, such as the Revenue Cycle Forum as it pertains to all three health systems.
• Liaison to all areas within Michigan Medicine relating to payer activity including key departments that directly interact with payers including Revenue Cycle, Care Management, Pharmacy, and the professional medical groups.
• Collaborate with the Manager, Managed Care Operations to ensure accurate and timely dissemination of payer-related information.
• Responsible for reviewing and responding to issues/concerns submitted from both internal and external constituents to the department shared email inbox in a timely manner.
• Create, coordinate, edit, and assist with PowerPoint presentations, Word documents, and Excel spreadsheets, as needed.
• Collaborate with the Manager, Managed Care Operations, to create and distribute periodic update reports for all functional/operational areas.
• Work in collaboration with team members within the MCCO Department.
• Other duties as needed and/or assigned

Required Qualifications:

• Bachelor's degree in healthcare administration, business, or related field is preferred. Equivalent work experience is acceptable.
• Minimum of four (4) years of experience working in the healthcare industry or managed care organizations.
• Excellent written and verbal communication skills, with the ability to convey complex information clearly and effectively.
• Strong interpersonal skills and ability to build and maintain relationships with diverse stakeholders both internal and external.
• Proficiency in Microsoft Office Suite, including but not limited to Microsoft Excel, PowerPoint, and Word.
• Detail-oriented with strong organizational, time management, and decision-making skills.
• Ability to work both independently and as part of a team environment in a hybrid environment.
• Ability to manage multi-faceted tasks in a fast-paced work environment while maintaining the level of detail critical to managed care operations

Desired Qualifications:

• Prefer to have experience with EPIC Electronical Medical Records System.
• Project management experience.

Modes of Work:

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment.

Background Screening:

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline:

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO Statement:

The University of Michigan is an equal employment opportunity employer.

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