Primary City/State:

Arizona, Arizona

Department Name:

Managed Care-Operations

Work Shift:

Day

Job Category:

General Operations

Primary Location Salary Range:

$33.03 - $55.05 / hour, based on education & experience

In accordance with State Pay Transparency Rules.

The future is full of possibilities. At Banner Plans & Networks, we’re changing the industry to reduce healthcare costs while keeping members in optimal health. If you’re ready to change lives, we want to hear from you.

 

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 a Managed Care Contract Consultant, you will leverage your experience in hospital contracting to negotiate agreements and amendments with health plans. You will participate in both internal and external meetings to discuss and negotiate terms with health plans. Your responsibilities will include negotiating across all hospital service lines, such as transplants, behavioral health, imaging, ambulatory surgery centers, acute rehabilitation, outpatient therapies, professional services, and others. Hospital contracting experience is required for this role.

The position is fully remote, with work hours from Monday to Friday during business hours according to the Arizona Time Zone. If you're interested in this role, we encourage you to 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. In addition, this position provides leadership and training to Contracts Management Specialists.

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.  Work independently to draft, review and revise proposed contracts and other related documents, ensuring compliance with company policy/guidelines and legal and regulatory requirements by working collaboratively with internal and external customers (including company and payer legal counsel).  Assess business terms to be sure the contract supports the company/business unit goals. Works directly with payers to negotiate and resolve contract issues, preparing contract documents for approval and execution by appropriate company leader.

2. Monitor contract renewals and solicit input from key internal stakeholders to identify contract revisions.  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. Maintains contract and correspondence file systems, key activity dates report (with corresponding notices of changes to external customers) and contract workflow log.

3. Develop relationships by collaborating with internal departments to successfully meet department and system strategic initiatives by initiating and maintaining effective channels of communication to ensure language memorializes Banner’s intent and protects Banner from harm.  Partners include but are not limited to Quality, Compliance, Risk, Legal, Credentialing, Medical Management, Banner Health Network, Revenue Cycle Management, Post-Acute Care.

4. Understand physician, facility and ancillary service contract reimbursement methodologies for Medicare, Medicaid, Exchange and Commercial fee for service products.  Collaborate with financial analytics team to prepare, analyze, review, and project financial impact of larger or complex payer contracts and alternate contract terms and validate accurate reimbursement terms are reflected in all contracts.  Understand value-based financial models including upside and downside risk models, including Medical Loss Ratio, Care Coordination Fees, CMS STARS and HEDIS quality metrics/measures.

5. Manage contracts for joint ventures, acquisitions and new facility openings.  Actively participate, lead and/or complete special projects, develop and implement tools for process improvements, and serve as a resource for contract interpretation.

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 Contracts Management Specialists, 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.

MINIMUM QUALIFICATIONS

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

Requires five plus years of experience preferably relating to contract negotiation drafting, preparation and analysis within the healthcare insurance industry. 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 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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