Managed Care Contract Specialist - Phoenix Children's

Company: Phoenix Children's Hospital
Location: Tolleson
Posted on: July 21, 2021

Job Description:

Position Summary

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.

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.

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.

Keywords: Phoenix Children's Hospital, Phoenix , Managed Care Contract Specialist - Phoenix Children's, Other , Tolleson, Arizona