Managed Care Contract Manager

Valleywise Health•Phoenix, AZ

About The Position

Under the direction of the Senior Director of Managed Care, the Managed Care Contract Manager is a 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. This position is responsible for negotiating managed care contracts as well as evaluating, analyzing, implementing, and monitoring contract rates and terms. Contract types may include hospital, professional, FQHC, and value-based for all payer types, including, but not limited to, Medicare, Medicaid, and Commercial payers. This contributes to the development and implementation of the strategic plan for managed care contracting, manages the contract audit and compliance function, maintains managed care contracting policies and procedures, and leads projects as assigned. Valleywise Health is committed to providing high-quality, comprehensive benefits designed to help our employees and their families stay physically and financially fit. Known for the diversity of not only the community of patients we serve but also our workforce and the benefits we offer, such as: Medical, Dental, and Vision Plans Flexible Spending Accounts 100% Retirement Match in the Arizona State Retirement System (ASRS) Paid Time Off and Paid Holidays Sick and Extended Illness Bank Tuition Reimbursement Programs And much more Salary Pay Range: $76,835.20 - $113,339.20

Requirements

Requires a Bachelor's in Business, Finance, Health Care Administration, or related field; or an equivalent combination of training and progressively responsible experience that will result in the required specialized knowledge and abilities to perform the assigned work.
Must have a minimum of five (5) years of progressively responsible provider contracting, network development and provider relations experience in developing, negotiating, and evaluating contracts and an operational background in either a payer or healthcare organization including business analysis and business development that demonstrates a high level of understanding of the required knowledge, skills, and abilities.
Must have knowledge and experience with Microsoft Office Suite applications including Excel, Word, PowerPoint, and Outlook.
Must have knowledge, experience, and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, value-based contracting, and managed care regulations.
Must be able to identifies opportunities for contract improvement by tracking issues prior to negotiations and obtaining input from key areas, including Revenue Cycle, Legal, etc.
Provides leadership with alternative strategies as well as recommendations for financial and operational improvements.
Must have knowledge of CPT, HCPCS, facility revenue codes and diagnosis codes.
Must have solid analytical and problem-solving skills.
Must be able to manage priorities in a dynamic environment and adapt to change quickly and positively.
Must demonstrate ability to be self-directed, as well as demonstrate excellent organizational, analytical, and interpersonal skills.
Must be able to work as a team member with peers, staff, and senior leadership.
Must possess good customer service and communications skills, the ability to work with professionals and maintain confidentiality standards.
Must be approachable, people oriented, and a good listener.
Must be a change agent able to develop, implement and maintain policies and processes.
Requires the ability to be a creative, independent thinker.
Must exhibit a high degree of professionalism, customer service, and enthusiasm, combined with the ability to build relationships with business and key stakeholders.
Requires the ability to read, write and speak effectively in English.

Nice To Haves

Prefers two (2) years comprehensive managed care contracting for integrated delivery system, Federally Qualified Health Center or multi-hospital system including behavioral health preferred.
Prefers three (3) years' experience reviewing, analyzing, and interpreting financial data as well as contract terminology.

Responsibilities

Negotiation of managed care contracts
Evaluating, analyzing, implementing, and monitoring contract rates and terms
Development and implementation of the strategic plan for managed care contracting
Manages the contract audit and compliance function
Maintains managed care contracting policies and procedures
Leads projects as assigned