Managed Care Contract Specialist - Phoenix Children's
Company: Phoenix Children's Hospital
Posted on: September 10, 2021
Posting Note: As a Managed Care Contract
Specialist for Phoenix Children's, you will be responsible for
evaluating, analyzing, negotiating, implementing, and monitoring
contract rates and terms. Contracts may include Phoenix Children's
Hospital, Phoenix Children's Medical Group, and Phoenix Children's
Care Network, and all related entities. Your analytical expertise
will focus on payment and operational issues that may be impacting
the process. Your understanding of MS-DRG methodology, "fee for
service", pay for performance, "bundle payments", and total cost of
care model experience will be a perfect fit for this position.
Schedule: M -F 8:00 a.m. - 5:00 p.m. Location: 3200 Camelback
Phoenix, AZ ( Temporarily "remote" due to our COVID policy. )
Requirements: 3 years of healthcare experience with a focus in
contract administration and negotiation, strong analytical skills
for evaluating financials, an understanding of standard and
innovative contract and reimbursement methodologies, including
service fee, pay for performance, bundled payments. Knowledge of
DRG and OPFS and total cost of care models required. Proficiency in
MS (EXCEL, WORD, PowerPoint) products is required.
This position evaluates, analyzes, negotiates, implements, and
monitors contract rates and terms within established contract
parameters and timeframes. Contracting may include Phoenix
Childrens Hospital, Phoenix Childrens Medical Group, Phoenix
Childrens Care Network and all related entities.
- Family-Centered care that focuses on the need of the child
first and values the family as an important member of the care
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- Participates in special projects as needed, including
evaluating feasibility of program development as it pertains to
payer operational requirements and reimbursement policies.
- 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.
- Performs miscellaneous job related duties as requested.
Keywords: Phoenix Children's Hospital, Peoria , Managed Care Contract Specialist - Phoenix Children's, Other , Peoria, Arizona
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