This position evaluates, analyzes, negotiates, implements, and monitors contract rates and terms within established contract parameters and timeframes. Contracting may include Phoenix Children’s Hospital, Phoenix Children’s Medical Group, Phoenix Children’s Care Network and all related entities.
The Managed Care Information Specialist will provide analytical and technological support and development of systems and processes to aid managed care negotiations, financial management, compliance and monitoring to ensure achievement of established financial /strategic goals. The Managed Care Information Specialist is required to fully understand and apply all elements from the Contract Exhibit Reimbursement, and build and maintain those terms in the EPSI Contract Module. The Managed Care Information Specialist is responsible to build and distribute both canned and ad-hoc reports in timely manner and to design meaningful summaries to aid in the decision process. This position reports to the Manager of Reimbursement and Managed Care Analytics
Under general supervision of the Transplant Financial Services Manager, this position serves as a liaison between hospital, patient and third party payors for all financial matters is secures all necessary authorizations to ensure transplant related services are approved by any third party payors before proceding with treatment. This position also ensures the patient/family has a thorough understanding of the transplant benefits available to them and any coveraged restrictions before a transplant is undertaken.