Primary City/State:

Colorado, Colorado

Department Name:

Managed Care-Operations

Work Shift:

Day

Job Category:

General Operations

Primary Location Salary Range:

$40.11 - $66.85 / hour, based on education & experience

In accordance with State Pay Transparency Rules.

Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle choices including remote & hybrid work options. Apply today.

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities.

In the role of Senior Managed Care Consultant, you will be responsible for negotiating agreements and amendments with health plans, necessitating hospital contracting experience. As a departmental subject matter expert, you will participate in both internal and external meetings, compare and redline documents, and negotiate agreements and amendments across all service lines, such as hospital, transplants, behavioral health, imaging, ambulatory surgery centers, acute rehabilitation, outpatient therapies, and professional services. Hospital contracting experience is required for this role.

Your work shifts are scheduled from Monday to Friday, adhering to the business hours of the Arizona Time Zone. The position is fully remote. If this role appeals to you, apply today!

Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position leads negotiations for managed care payer contracts on behalf of the organization. This position participates in the development and implementation of contract management tools and processes to assist in achieving the organizations contracting objectives and strategies. This position mentors, leads and trains Managed Care Contracts Consultants. This position manages the relationship between Service Line leaders, Service Line staff, and Managed Care. This position co-leads assigned special projects.

CORE FUNCTIONS

1. Negotiate and manage multiple complex payer fee for service and value-based contracts with insurance companies on behalf of Banner Health, all lines of business (e.g., hospitals, transplants, behavioral health, ancillaries, physician groups), and Banner Health Network. Assess business terms to be sure the contract supports the company/business unit goals.

2. Conduct analyses and compiles information for review of strategic contract terms for management review and decision making to specified areas of concern. Participates in contract monitoring and support tools (matrices), by reviewing and interpreting contracts, extracting key information for use by internal and/or external customers, and keeping abreast of changes in company locations for inclusion in various matrices.

3. Build and maintain relationships by collaborating with internal departments to successfully meet department and system strategic initiatives.

4. Extensive knowledge of fee-for-service and value-based contract reimbursement for the purpose of protecting Banner Health and the Insurance Division legally and financially.

5. Subject matter expert and Managed Care lead for joint ventures, acquisitions, new facility/ancillary openings, and special projects. Responsible for providing current information to colleagues for the purpose of document execution and payer communication.

6. Build relationships that cultivate health plan partnerships. Serve as a resource for internal and external clients to interpret contract language and resolve contract issues by reviewing and interpreting contract terms and originating contract documentation. Assist in resolving elevated and complex payer concerns. Research problems and negotiate with internal/external partners/customers to resolve escalated issues.

7. Provide leadership and training to Managed Care Contracts Consultants, including but not limited to reviewing and editing contract language in various documents, training new staff on essential department processes/communication flows, and serving as the primary resource for questions on complex and/or sensitive agreements. Responsible for mentorship and development of Managed Care Contracts Consultants, including intradepartmental introductions and relationship building.

8. Addresses challenges and obstacles with a positive solution-oriented mindset.

MINIMUM QUALIFICATIONS

Experience consistent with a bachelor’s degree in business, healthcare or related field required.

Requires seven years of contract negotiation experience. Must possess demonstrated skill in problem analysis and resolution; contract management; oral and written communication. Requires problem solving skills and complex decision-making skills. Requires highly developed interpersonal and listening skills. Must be detail oriented. Must be able to function independently, possess demonstrated flexibility in multiple project management.

Experience in negotiating and administering health care insurance government and commercial payer contracts. Possess the interpersonal skills to interact effectively and cultivate supportive relationships with internal customers, managed care payors, consultants, outside agencies, and internal/external corporate executives.

Ability to manage and lead all contractual aspects of major projects.

Excellent written, proofreading, and verbal communication skills. Requires strong computer skills.

Must have a strong knowledge of healthcare industry financial indicators and an in depth understanding of Commercial, AHCCCS and CMS reimbursement methodologies.

Assignments in Managed Care require strong contract writing skills as well as a general understanding of health care claims.

PREFERRED QUALIFICATIONS

For assignments in Managed Care, specific managed care contract experience is highly preferred.

Additional related education and/or experience preferred.

Anticipated Closing Window (actual close date may be sooner):

2025-01-01

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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