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Position Details

Department: Managed Care Contracting
Category: Managed Care
Location: Phoenix
Posting #: 352888
Date Posted: 9/1/2017
Employee Type: Regular

Position Summary

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.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. In collaboration with leadership, identifies appropriate contracting and re-contracting opportunities and initiates discussions with key constituents. For new relationships or service lines, performs business and market analysis to determine viability of contracting. Collaborates with managed care organizations and internal stakeholders to gain a thorough understanding of payer-specific requirements, reimbursement logic, and limitations. Ensures contracting efforts remain aligned with enterprise goals.
  2. Leads contract discussions with managed care organizations, including rate and language negotiations in accordance with established guidelines. Leads development of rate and language proposals. Collaborates with internal staff on modeling of rate proposals. Ensures contract terms can be administered and monitored in a cost effective manner. Effectively interfaces with management, clinical, operations, and administrative staff to ensure contract negotiations are completed in accordance with critical dates and within approved financial parameters.
  3. Manages all aspects of the contract life-cycle. Collaborates to assemble and gain an understanding of payer specific data, operational issues, and business review. Implements executed contracts cross-functionally, communicates contract changes internally, maintains appropriate documentation, reviews contract performance reports and makes appropriate recommendations.
  4. Facilitates problem solving of escalated contractual and operational issues through collaboration with managed care organizations and internal stakeholders. Identifies and communicates opportunities for process improvement with managed care organizations and internal stakeholders.
  5. Coordinates with analytical team to ensure contractual terms, including payer-specific requirements, reimbursement logic, and limitations are understood and appropriately included in any modeling systems. Serves as the expert on all terms of the payer contract for both internal and external parties.
  6. Participates in special projects as needed, including evaluating feasibility of program development as it pertains to payer operational requirements and reimbursement policies
  7. Stays abreast of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement in the financial and operational components of managed care contracts. Leads discussions pertinent to contract performance, market changes, market intelligence, and strategic decision making.
  8. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
Education
1. Bachelor’s Degree in Business, Finance, Healthcare Administration, or another business related field of study required or 3 years of experience in network management, contracting, and/or relations in a healthcare field. Required
Do you meet this requirement?
Experience
1. Minimum three years of healthcare industry experience, with an emphasis on contract negotiation and administration. Required
2. Experience in evaluating, analyzing, and presenting financial information. Required
3. Comprehensive knowledge of healthcare managed care principles. Required
4. Experience with standard and innovative contract and reimbursement methodologies, including fee for service, pay for performance, bundled payments including but not limited to DRG and OPFS, and total cost of care models. Required
5. 5 years of comprehensive managed care contracting experience with a healthcare organization or health plan. Preferred
6. Comprehensive knowledge of advanced managed care principles including risk contracting, value-based contracting, and capitation. Preferred
7. Experience working with hospital, large medical group, CIN, IPA, or PHO. Preferred
8. Experience with state and federal programs such as Medicare and Medicaid Preferred
Do you meet this requirement?
Special Skills
1. In-depth knowledge of revenue codes, CPT codes, and HCPCS codes. Required
2. Proficient in Microsoft Excel, Access, Word, Outlook, PowerPoint and Internet. Required
3. Excellent written and oral (presentation) skills. Strong analytical and project management skills. Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands. Ability to prioritize and handle multiple tasks in a demanding work environment. Demonstrated organizational skills. Ability to work effectively under deadlines and produce accurate work. Ability to communicate complex issues effectively. Required
4. Demonstrated ability to drive results and take initiative. Required
5. Strong understanding of the managed care environment, including, but not limited to, managed care policies and procedures, reimbursements mechanisms, billing principles, and practice management/medical office procedures. Required
6. Must have a strong understanding of health care delivery systems, specifically commercial and government-sponsored programs, such as Medicaid. Understand healthcare markets, advanced financial skills, Health & Benefit products, services. Required
7. Maintain confidentiality and privacy. Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Occasionally
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Occasionally
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Frequently
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Occasionally
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Frequently
13. Physical Requirement - Near Vision Constantly
14. Physical Requirement - Far Vision Frequently
15. Physical Requirement - Color Discrimination Occasionally
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Occasionally
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply