Managed Care Contract Manager

Company Overview Shriners Children's Hospital is an organization that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families. Job Overview This position is responsible for continuously exemplifying the mission, vision, values, and customer service philosophy of SHC in job performance and in service to other persons and customers both internally and externally. This position is responsible for assuming lead in negotiations with national, regional and local payors and subsequent renewals and ongoing contract administration as assigned and with discretionary authority, maintaining management of technology applications used to manage network management contract files, contract language analysis, oversight of contract language data entry, network payor manuals, document approval tracking, scanning, oversight of preparation of correspondence, oversight of coordination of contract implementations and terminations, and other related duties as assigned which will include a variety of network management and provider relations functions. This position is also responsible for understanding any technology applications utilized to manage contract rates vs. payments (e.g. Variance Tools), and is responsible for working in conjunction with other departments including back end revenue cycle and IT to ensure the accuracy of the Variance Tools through periodic audits. This position generally assumes a lead role in working with the network management team within the revenue cycle department. The pay range for this position is $101,460-$126,825/annually. Compensation is determined based on years of experience and department equity. Responsibilities Responsible for developing and maintaining external third-party pay and other related provider and Plan contractual relationships to support the current and future strategic financial goals, mission, vision, and values Responsible for proactively planning and prioritizing third-party pay negotiations to support the system, facilities, and market growth and development This position may require additional focus, assistance, and evaluation of opportunities/strategies in the areas of Government Programs, e.g., Medicaid / Managed Medicaid, Alternative Payment Models, Shriners Children's Medical Group, and any other emerging reimbursement models, which necessitates contracting Responsible for maintenance of payor/provider relations and other payor relations functions, including provider education, marketing, contract compliance, and third-party pay agreement administration This position will work with internal stakeholders on a continuous quality improvement cycle of the review and management of contracts to determine when it is appropriate to pursue renewals, necessity updates, and potential termination of contract agreements This is not an all-inclusive list of this job's responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned. Qualifications Minimum: Bachelors Degree in healthcare or related field 10+ years experience in a healthcare setting 5+ years in payer relations (provider relations, professional contracting, hospital contracting) in a managed care setting Preferred: 7+ years experience in a managed care/health system setting with contractual negotiations, contractual terms and reimbursement methodologies