Health Alliance Plan by Henry Ford Health is a Michigan-based, nonprofit health plan that provides health coverage to individuals, companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.

GENERAL SUMMARY:

This role sits at the intersection of business, IT, and operations—owning system configuration, ensuring compliance, driving quality, and enabling efficient issue resolution and system enhancements.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Initiate the analysis of, and ensure adequate evaluation of, system impacts. Serve as the system expert for customer bases and IT departments.
• Prepare recommendations for enhancements to system applications/vendors.
• Coordinate BCT efforts and customer needs to ensure expeditious response and resolution of system problems/issues.
• Perform ongoing quality review checks to ensure a superior product for on-going production support.
• Responsible for the performance of the application software based on customer requirements and ensuring that systems conform to Government Programs, and Regulatory Agency Standards.
• Assist in the analysis and testing of new Facets releases while identifying the impact to interfaces for externally developed packages.
• Participate in corporate project meetings to disseminate the customer's needs and priorities to corresponding team leadership.
• Interact with other departments and divisions within Health Alliance Plan and Henry Ford Health to establish consistent interpretation of various policies and procedures throughout the system.
• Perform other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in computer science or business administration.
• Related and relevant experience may be considered in lieu of academic requirements. Related experience is defined as six (6) years’ experience in Health Care related business and/or claims processing system configuration.
• Two (2) years of claims processing system configuration experience or demonstrated proficiency through relevant Health Alliance Plan specific business experience.

Preferred:

• Five (5) years of Health Care related business experience preferred.
• Knowledge of Facets claims processing with the ability to troubleshoot.
• Ability to work at a fast pace in a constantly changing environment.
• Ability to Interpret Member and Group contracts and translate into Benefit configuration.
• Analytical thinking required for troubleshooting configuration-related defects
• Experience developing Service IDs, Supplemental Mapping, Service Rules, Variable Components, Product Component Configuration in Facets.
• Knowledge of Facets Group, billing, class/plan configuration in Facets
• Experience in open enrollment processes preferred (new Plan/Product creation, passive enrollment, Mass member transfer etc.)
• Knowledge of claim processing, accumulators, provider reimbursement, member eligibility and authorizations
• SQL experience preferred (Oracle and SQL Server)
• Certified Medical Coder preferred
• Demonstrated ability to research, analyze, design, plan, organize, coordinate, implement, and perform necessary follow-up and closure procedures for system related projects.
• Demonstrated ability to collect and prepare data for written/oral presentations.
• Demonstrated ability to communicate effectively.
• Ability to interact with outside sources and maintain professional contacts.
• Excellent written and verbal communication skills are essential.
• Must be able to work effectively with persons of varying position levels and diverse interests.
• Understanding of healthcare industry and managed care concepts.
• Knowledge of a table-driven claims processing system.
• Knowledge of Windows, Microsoft Excel and Word, Query Tools (COGNOS, etc.) and Implementation/Administration of Packaged Claims Processing Applications.
• A high level of human relations skills.
• Ability to adapt to a constantly changing environment.