Contracts Manager, Managed Care

Position Details

Department: CORP | Managed Care Contracting
Category: Managed Care
Location: Telecommuting
Employee Type: Regular
Posting #: 629701
Posted On: 11/16/2021
Recruiter:
Danielle Hopkins
Recruiter:
Danielle Hopkins

Position Summary

The Contracts Manager, Managed Care is the subject matter expert on all managed care contract terms and conditions and has primary responsibility for negotiation, implementation and performance review of assigned managed care contracts. Contracting may include Phoenix Children`s Hospital, Phoenix Children`s Medical Group, Phoenix Children`s Care Network and all related entities.

Position Duties

  1. Oversees the contract management cycle.
    • Leads and has primary responsibility for high-profile contracts, as assigned, on an ongoing basis. Initiates and oversees pre-negotiation activities including model preparation, market analysis, contract language and rate negotiations, contract implementation, and contract performance phases within specified time periods.
  2. Leads the development of contract proposals for negotiations.
    • Identifies opportunities for contract improvement by tracking issues prior to negotiations and obtaining input from key areas, including; Pre-Access, Revenue Cycle, Legal, etc. . Provides leadership with alternative strategies as well as recommendations for financial and operational improvements.
  3. Leads contract negotiations with Payers on behalf of Phoenix Children`s.
    • Initiates contract discussions with Payers, including; contract language and rate negotiations. Effectively collaborates with management, legal, analytics, clinical, operations, and administrative teams to ensure successful contract negotiations are undertaken in a cost effective manner and contract negotiations are completed in accordance with critical dates and within approved financial parameters. Ensures contract language reflects approved contract terms and conditions.
  4. Effectively manages payer contract relationships.
    • Serves as the lead and primary contact for payers as well as internal staff at all levels, including leadership. Establishes and maintains positive working relationships with payer contacts. Maintains open lines of communication between Phoenix Children`s and health plans or payers. Facilitates collaborative discussions for problem solving. Communicates opportunities for process improvement.
  5. Reports on status of payer contracts and negotiations.
    • Maintains current contract status and negotiation status in Contract Management system and other prescribed documents. Prepares status reports or dashboards as specified in Managed Care documentation. Prepares and distributes Executive Summary and other necessary documentation/notifications upon completion of contract negotiations.
  6. Acts as subject matter expert for all matters related to payer contracts.
    • Stays abreast of changing health care 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. Stays abreast of payer fee schedule and policy changes. Effectively interfaces with other team members to ensure contract terms, rates, conditions, and policies are clearly understood. Facilitates securing information needed for fact-based decision-making.
  7. 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

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Education
Do you meet this requirement?
1. Bachelors Degree in Business, Finance, Health care Administration, or related required field. An additional five (5) years of comprehensive managed care contract management and negotiation experience may substitute for degree requirement.
Required
2. MBA or MHA
Preferred
Experience
Do you meet this requirement?
1. Ten (10) years experience reviewing, analyzing and interpreting financial data as well as contract terminology.
Required
2. Five (5) years comprehensive managed care contracting experience with a major insurer, health care provider organization, hospital, large medical group, CIN, IPA, or PHO.
Required
3. Experience with state and federal programs such as Medicare and Medicaid.
Required
4. Comprehensive knowledge of health care managed care principles.
Required
5. In depth understanding of hospital, professional and technical billing codes and reimbursement models, including but not limited to, DRG, APR DG, RBRVS, CPT, HCPCS, CRGs, et al.
Required
6. Knowledge of legal and regulatory requirements associated with fee-for-service and managed care Value-based contracting for professional services.
Required
Certifications / Licenses / Registries
Do you meet this requirement?
1. Certified Health care Financial Professional with Health care Financial Management Association. (HFMA).
Preferred
Special Skills
Do you meet this requirement?
1. Proficiency with Microsoft Professional Suite of applications, particularly Microsoft Word, Excel, Outlook, and PowerPoint.
Required
2. Strong communication skills with ability to represent organization in a positive and credible manner concisely either in person, in writing or via telecommunications.
Required
3. Ability to manage multiple tasks and re-prioritize as necessary.
Required
4. In-depth knowledge of negotiating strategies, tactics and methods to achieve desired outcomes.
Required
5. Strong analytical and project management skills.
Required
6. Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands.
Required
7. Ability to prioritize and handle multiple tasks in a demanding work environment.
Required
8. Demonstrated organizational skills.
Required
9. Ability to work effectively under deadlines and produce accurate work.
Required
10. Ability to communicate complex issues effectively.
Required
11. Maintain confidentiality and privacy.
Required
12. Must have a strong understanding of health care delivery systems, specifically commercial and government-sponsored programs, such as Medicaid.
Required
13. Understand health care markets, advanced financial skills, Health & Benefit products, services.
Required
14. Demonstrated ability to drive results and take initiative.
Required
15. 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
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 - Occasionally
9. Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally
10. Physical Requirement - Talking - Constantly
11. Physical Requirement - Walking - Frequently
12. Physical Requirement - Near Vision - Constantly
13. Physical Requirement - Far Vision - Occasionally
14. Physical Requirement - Color Discrimination - Occasionally
15. Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
16. Physical Requirement - Lift up to 35 pounds without assistance - Occasionally
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply