Director Hospital Reimbursement and Analytics

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Compensation and Benefits Package

Overview: Responsible for developing next generation of hospital payment monitoring tools and processes (post PHA contract revisions) that allow for continuous review and detection of hospital payment issues that may conflict with existing hospital contracts, medical policy and payment policies.
Responsibilities: <ul><li>Oversee the design, development and implementation of an enhanced suite of tools designed to detect variances in hospital payments from BCBSM’s existing hospital contract terms, existing medical and payment policies.</li><li>Support Hospital Contracting area’s work with hospitals as it relates to contract negotiations and evaluations, performance opportunities under value-based payment arrangements and other Hospital Contracting needs as they arise.</li><li>Act as the primary liaison with key areas of the company to include Actuarial Services, Customer Reporting, and other business analytical areas embedded in the business segments of Senior Health Services (SHS), Health Plan Business (HPB) and Health Care Value (HCV).</li><li>Ensure continued staff development, coaching and mentoring.</li><li>Oversee the staff involved in hospital settlements and BCBSM Interim Payment (BIP) monitoring during the period where settlements will still be required.</li><li>Oversee the transition of staff who are involved in the BIP, Hospital Settlement and Appeals.</li><li>Develop and design next generation provider payment monitoring tools to flag potential areas of payment breaches and/or provider billing practices that may need to be investigated for potential recovery or other intervention strategies.</li><li>Work with other data analytic areas of the Company to include Actuary, Customer Reporting, SHS Analytics and HCV Analytical areas in order to ensure consistency in data models and approaches to identifying customer opportunity.</li><li>Provide routine analytical support to Provider Contracting.</li><li>Ensure continued staff development, coaching and mentoring. </li></ul>
Requirements: <ul><li>Bachelor’s degree in Business Administration, Accounting or related field required. Master’s degree preferred. </li><li>10 years of experience in hospital finance and revenue cycle processes required. </li><li>5 years of experience in leading a data analytic team required. </li><li>Excellent leadership, organizational, verbal and written communication skills. </li><li>Strong analytical skills that include critical thinking, scientific inquisitiveness, complex modeling skills, and ability to analyze reports to isolate areas requiring further analyses. </li><li>Ability to develop and lead teams, directly and indirectly. </li><li>Strong understanding of SAS, Sequel, Tableau and other software tools that are used to query large databases and produce sophisticated reports. </li><li>Ability to collaborate with multiple business areas. </li></ul>