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Supervisor- Medicare Advantage & Direct Pay Job
Date: Apr 28, 2012
Location: Southfield, MI, US
Supervisor- Medicare Advantage & Direct Pay
Requisition #: 67655
Status: Full-Time with Full-Time Benefits (40 Hours)
Business Unit: Health Alliance Plan (HAP)
Shift: Days
MEMBERSHIP & BILLING GOVT
Weekends: No
Job Family: Accounting/Finance
Job Function: Leadership/Management
Campus/Job Location: Health Alliance Plan (HAP) Preferred
Location (State/City): US-MI-Southfield
More information about this position
Overview
Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you!
Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and education. Our system includes the 1,200-member Henry Ford Medical Group, six hospitals, Health Alliance Plan, 32 primary care centers and many other health-related entities throughout Southeast Michigan. Founded in 1915 by auto pioneer Henry Ford, we continue to be committed to improving the health and well-being of a diverse Michigan community. In 2009 alone, Henry Ford Health System provided more than $173 million in uncompensated care. Henry Ford also is a major economic driver in Michigan and employs more than 23,000. Our health system is led by CEO Nancy Schlichting.
To supervise and coordinate the activities of the Government Programs and Direct Pay divisions of Membership and Billing. Ensure the efficient and timely processing of Medicare Advantage (MA), Medigap, PDP and Medicare Advantage Prescription Drug Program (MAPD) enrollment and disenrollment activity within CMS regulatory compliance, supervises direct pay billing processes, ensures the issuance of identification cards within department standards, assists in the dependent audit process as necessary, and ensures all data files are received, processed, and reported. In addition, this position is responsible for the payment reconciliation of HAP's Medicare Advantage and Direct Pay membership and identification and resolution of all payment discrepancies. Medicare Advantage data collection, reporting, analysis, and trending of issues which increase the effectiveness of the Medicare teams' processes as well as ensures data integrity is maintained.
Responsibilities
Direct supervisory responsibilities include, coaching, counseling, evaluation of employee's performance and implementing disciplinary action within are of responsibility. Identify training, personnel and other resource needs as appropriate.
-2. Design, implement and maintain processes to ensure the completeness and accuracy of the information sent to the Center for Medicare & Medicaid Services (CMS) for the Medicare Advantage members.
-3. Supply necessary internal control oversight over information system changes affecting MA specific Membership & Billing processes to ensure proper system testing, system documentation, user training, etc. is performed prior to implementation.
-4. Develop MA specific operational policies and procedures in accordance with CMS Regulations and within departmental standards.
-5. Communicate with Marketing, BCT, Reconciliation, DST, and CMS in the resolution of problem situations impacting MA and all direct pay billing activities.
-6. Supervise, develop, coordinate and control enrollment and disenrollment, and payment reconciliation workflow activities in the Membership & Billing Department.
-7. Design, implement and maintain processes to reconcile and monitor the premium payments from CMS for the Medicare Advantage Programs.
-8. While working with the immediate Manager, initiate research on impending CMS regulations regarding future changes to data submissions for sending and receiving membership file exchanges and processing newly implemented CMS data files. Requires interacting with other HAP operating departments to ensure compliance with the changing requirements.
-10. Develop, design, test and approve changes and enhancements to the membership and billing system as it relates to MA and direct pay.
-11. Work with all levels within the team to ensure regulatory compliance (NCQA, HEDIS, HIPAA, and CMS).
13. Participate in weekly/monthly Medicare Advantage conference calls, and attend Med Impact conference calls as needed to ensure accurate and timely documentation of changes. Ensure that changes are effectively communicated and resolved quickly.
14. Work closely with Finance, Pharmacy, DST, ECT, and BCT to create and implement systematic MA membership and billing data models in addition to automated audit tools. Monitor the processes to ensure data integrity.
15. Participate in Medicare Advantage workgroups to ensure successful achievement of corporate objectives.
16. Perform other related duties as assigned.
Qualifications
Education
1. Bachelor's Degree in Health Care, Business Administration, or a related field
2. Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of academic requirements
B. Experience
1. Three (3) years of experience in a health care or insurance system environment
2. Two (2) years of experience in a Membership and Billing Department or Client Service Operations with specific work in Medicare and/or government programs
3. Two (2) years of lead, project management or data operational level responsibility
C. Abilities
1. Excellent written and verbal communication skills
2. Proven analytical, problem solving and decision making skills
3. Ability to comprehend and suggest modification to technical computerized systems
4. Demonstrated the ability to plan and organize effectively
5. Ability to effectively lead a team
6. The ability to effectively analyze data from the reports and provide detailed analysis and trending
D. Knowledge
1. A well defined understanding of health plan operations
2. Technical understanding of database oriented computer systems – Peradigm, Hits, Oracle, etc.
3. Proficient in Microsoft products such as Word, Excel and/or Access
4. Working knowledge of various Medicare plans to include a keen understanding of regulations and regulatory product compliance
Equal Employment Opportunity
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.
Requisition #: 67655
Status: Full-Time with Full-Time Benefits (40 Hours)
Business Unit: Health Alliance Plan (HAP)
Shift: Days
MEMBERSHIP & BILLING GOVT
Weekends: No
Job Family: Accounting/Finance
Job Function: Leadership/Management
Campus/Job Location: Health Alliance Plan (HAP) Preferred
Location (State/City): US-MI-Southfield
More information about this position
Overview
Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you!
Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and education. Our system includes the 1,200-member Henry Ford Medical Group, six hospitals, Health Alliance Plan, 32 primary care centers and many other health-related entities throughout Southeast Michigan. Founded in 1915 by auto pioneer Henry Ford, we continue to be committed to improving the health and well-being of a diverse Michigan community. In 2009 alone, Henry Ford Health System provided more than $173 million in uncompensated care. Henry Ford also is a major economic driver in Michigan and employs more than 23,000. Our health system is led by CEO Nancy Schlichting.
To supervise and coordinate the activities of the Government Programs and Direct Pay divisions of Membership and Billing. Ensure the efficient and timely processing of Medicare Advantage (MA), Medigap, PDP and Medicare Advantage Prescription Drug Program (MAPD) enrollment and disenrollment activity within CMS regulatory compliance, supervises direct pay billing processes, ensures the issuance of identification cards within department standards, assists in the dependent audit process as necessary, and ensures all data files are received, processed, and reported. In addition, this position is responsible for the payment reconciliation of HAP's Medicare Advantage and Direct Pay membership and identification and resolution of all payment discrepancies. Medicare Advantage data collection, reporting, analysis, and trending of issues which increase the effectiveness of the Medicare teams' processes as well as ensures data integrity is maintained.
Responsibilities
Direct supervisory responsibilities include, coaching, counseling, evaluation of employee's performance and implementing disciplinary action within are of responsibility. Identify training, personnel and other resource needs as appropriate.
-2. Design, implement and maintain processes to ensure the completeness and accuracy of the information sent to the Center for Medicare & Medicaid Services (CMS) for the Medicare Advantage members.
-3. Supply necessary internal control oversight over information system changes affecting MA specific Membership & Billing processes to ensure proper system testing, system documentation, user training, etc. is performed prior to implementation.
-4. Develop MA specific operational policies and procedures in accordance with CMS Regulations and within departmental standards.
-5. Communicate with Marketing, BCT, Reconciliation, DST, and CMS in the resolution of problem situations impacting MA and all direct pay billing activities.
-6. Supervise, develop, coordinate and control enrollment and disenrollment, and payment reconciliation workflow activities in the Membership & Billing Department.
-7. Design, implement and maintain processes to reconcile and monitor the premium payments from CMS for the Medicare Advantage Programs.
-8. While working with the immediate Manager, initiate research on impending CMS regulations regarding future changes to data submissions for sending and receiving membership file exchanges and processing newly implemented CMS data files. Requires interacting with other HAP operating departments to ensure compliance with the changing requirements.
-10. Develop, design, test and approve changes and enhancements to the membership and billing system as it relates to MA and direct pay.
-11. Work with all levels within the team to ensure regulatory compliance (NCQA, HEDIS, HIPAA, and CMS).
13. Participate in weekly/monthly Medicare Advantage conference calls, and attend Med Impact conference calls as needed to ensure accurate and timely documentation of changes. Ensure that changes are effectively communicated and resolved quickly.
14. Work closely with Finance, Pharmacy, DST, ECT, and BCT to create and implement systematic MA membership and billing data models in addition to automated audit tools. Monitor the processes to ensure data integrity.
15. Participate in Medicare Advantage workgroups to ensure successful achievement of corporate objectives.
16. Perform other related duties as assigned.
Qualifications
Education
1. Bachelor's Degree in Health Care, Business Administration, or a related field
2. Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of academic requirements
B. Experience
1. Three (3) years of experience in a health care or insurance system environment
2. Two (2) years of experience in a Membership and Billing Department or Client Service Operations with specific work in Medicare and/or government programs
3. Two (2) years of lead, project management or data operational level responsibility
C. Abilities
1. Excellent written and verbal communication skills
2. Proven analytical, problem solving and decision making skills
3. Ability to comprehend and suggest modification to technical computerized systems
4. Demonstrated the ability to plan and organize effectively
5. Ability to effectively lead a team
6. The ability to effectively analyze data from the reports and provide detailed analysis and trending
D. Knowledge
1. A well defined understanding of health plan operations
2. Technical understanding of database oriented computer systems – Peradigm, Hits, Oracle, etc.
3. Proficient in Microsoft products such as Word, Excel and/or Access
4. Working knowledge of various Medicare plans to include a keen understanding of regulations and regulatory product compliance
Equal Employment Opportunity
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.
Nearest Major Market: Detroit
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