Position Summary

The Senior Contract Specialist, Managed Care, is the 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. Contracting may include Phoenix Children`s Hospital, Phoenix Children`s Medical Group, Phoenix Children`s Care Network and all related entities.

Education

• Bachelors Degree in Business, Finance, Health care Administration, or related required field. An additional five (5) years of comprehensive managed care contract management and negotiation experience may substitute for degree requirement. (Required)
• MBA or MHA (Preferred)

Experience

• Ten (10) years comprehensive managed care contracting experience with a major insurer, health care provider organization, hospital, large medical group, CIN, IPA, or PHO. (Required)
• Ten (10) years experience reviewing, analyzing and interpreting financial data as well as contract terminology. (Required)
• Experience with state and federal programs such as Medicare and Medicaid. (Required)
• Comprehensive knowledge of health care managed care principles. (Required)
• In depth understanding of hospital, professional and technical billing codes and reimbursement models, including but not limited to, DRG, APR DG, RBRVS, CPT, HCPCS, CRGs, et al. (Required)
• Knowledge of legal and regulatory requirements associated with fee-for-service and managed care Value-based contracting for professional services. (Required)

Certifications

• Certified Health care Financial Professional with Health care Financial Management Association. (HFMA). (Preferred)

Special Skills

• Proficiency with Microsoft Professional Suite of applications, particularly Microsoft Word, Excel, Outlook, and PowerPoint. (Required)
• Strong communication skills with ability to represent organization in a positive and credible manner concisely either in person, in writing or via telecommunications. (Required)
• Ability to manage multiple tasks and re-prioritize as necessary. (Required)
• In-depth knowledge of negotiating strategies, tactics and methods to achieve desired outcomes. (Required)
• Strong analytical and project management skills. (Required)
• Ability to work both independently and in a dynamic team environment with rapidly changing priorities and demands. (Required)
• Ability to prioritize and handle multiple tasks in a demanding work environment. (Required)
• Demonstrated organizational skills. (Required)
• Ability to work effectively under deadlines and produce accurate work. (Required)
• Ability to communicate complex issues effectively. (Required)
• Maintain confidentiality and privacy. (Required)
• Must have a strong understanding of health care delivery systems, specifically commercial and government-sponsored programs, such as Medicaid. (Required)
• Understand health care markets, advanced financial skills, Health & Benefit products, services. (Required)
• Demonstrated ability to drive results and take initiative. (Required)
• Strong understanding of the managed care environment, including, but not limited to, managed care policies and procedures, reimbursements mechanisms, billing principles, and practice management/medical office procedures. (Required)