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Job ID92069

LocationAurora, Colorado

Full/Part TimeFull-Time

Regular/TemporaryRegular

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Why Work at Children's....

Here, it's different. Come join us. Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years. Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day. We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report. As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties. Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat. That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through o A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.

Job Overview

The Payer Contracting Manager provides ongoing oversight and monitoring of a portfolio of payer agreements, programs and services on behalf of the organization and other related ventures.Acts as primary negotiator and manager of facility, provider, ancillary and value based payer agreements from a variety of sources including but not limited to commercial, governmental, specialty, and single case agreements.

Additional Information

Department Name: Managed Care - Pediatric Care Network Job Status: Full time, 40 hours per week. Shift: Monday to Friday, 8am to 4:30pm, Hybrid

Qualifications

Education:Bachelor's degree in Business, Finance or Health Care Administration. Experience:5 years of negotiation or related experience in healthcare or managed care industry with direct payer or provider contracting experience.General accounting experience with advanced analytical skills, verbal and written communication skills, and negotiation skills. Preferred value based contracting, clinical intergrated network and accountable care organization experience. Equivalency: In lieu of a Bachelor's degree, one year of professional experience will serve as an equivalency to one year of education.

Responsibilities

POPULATION SPECIFIC CARE No direct patient care. ESSENTIAL FUNCTIONS An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform. 1.Negotiates and manages a portfolio of fee-for-service contracts with third party payers and other contracting entities in conjunction with Director that optimizes revenue, margin and growth in alignment with strategic objectives. 2.Monitors and coordinates financial analysis of payer contract performance and modeling projections based on alternate contract agreements with payers and adverse trends. Works with the financial analysts, has primary responsibility for contract performance and tracking. 3.Deve ops payer proposals including customer needs assessment, pricing, procedural and operational systems. Responds to proposals received and coordinates with all necessary departmental staff to ensure a comprehensive response. 4.Makes recommendations regarding participation or non-participation with new or existing agreements. Adheres to all established contracting language and financial guidelines and parameters 5.Assist in producing and disseminating contract information to all relevant departments; assists to identify and resolve problems that arise with contracts including billing, claims payment, scheduling, registration, credentialing, service development, and care management, noncompliance. 6.Represents the organization in establishing business relationships with payers. Utilize communication and organizational skills to work