Insurance Contract Administrator - Full Time- Hybrid/Troy

To develop, maintain, implement and monitor contractual relationships with third party Insurance Payors on behalf of HFHS and its business units.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Under supervision of Director or Managed Care Contracting, works directly with Payors to negotiate contractual provisions and rates on behalf of HFHS Hospitals, Medical Group, Behavioral Health Services and other business units.
2. Independently evaluate and analyze contract proposals including completing initial proposal responses and reviewing/revising contract language and operational requirements. Reviews contracts with in house legal-council and works through contract revisions with Payors.
3. Routinely monitor current contracts for appropriate rate structure, contract terms and annual renewals and/or re-negotiations and compliance with industry standards and guidelines.
4. Monitor marketplace for new contracting opportunities and make recommendations of changes to enhance HFHS contract portfolio.
5. Coordinate implementation of Payor arrangements and provide ongoing education and support throughout HFHS.
6. Collect and communicate relevant contractual requirements and issues to internal customers such as Utilization Management, Finance, Patient Billing, Administration, Legal, etc. Information includes; payor relationships, operational requirements and contract terms.
7. Maintain comprehensive files of HFHS contractual relationships and update contract information in the contract database.
8. Maintain contract summaries on HFHS website (Henry).
9. Act as liaison between HFHS and Payors on contracting and operational issues, i.e. billing, utilization review, credentialing site visits, notification of site closures or new services.
10.Coordinate facility credentialing and re-credentialing.
11.Perform other duties as assigned.