As part of our continued commitment to providing a safe and healthy workplace, Phoenix Children’s is officially a mandatory COVID-19 vaccination organization, effective October 1, 2021. All new employees must be fully vaccinated prior to starting employment at Phoenix Children’s. Having a vaccinated workforce is an important step in supporting our mission to provide hope, healing and the best healthcare for the children in our community.
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Position Details

Department: CORP | Managed Care Contracting
Category: Managed Care
Location: Phoenix
Posting #: 670638
Date Posted: 4/27/2022
Employee Type: Regular

Position Summary

The Senior Contract Specialist, 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.

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. 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; Preaccess, 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.

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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. 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
Do you meet this requirement?
Experience
1. Ten (10) years comprehensive managed care contracting experience with a major insurer, health care provider organization, hospital, large medical group, CIN, IPA, or PHO. Required
2. Ten (10) years experience reviewing, analyzing and interpreting financial data as well as contract terminology. 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
Do you meet this requirement?
Certifications/Licenses/Registries
1. Certified Health care Financial Professional with Health care Financial Management Association. (HFMA). Preferred
Do you meet this requirement?
Special Skills
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
internal/external
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply