Managed Care Contract Specialist

Position Details

Department: PCH-MAIN | Managed Care Admin
Category: Managed Care
Location: Phoenix
Employee Type: Regular
Posting #: 412748
Posted On: 9/5/2018

Position Summary

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.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable
The position has been closed or filled.

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