Managed Care Payer Contract Manager

The Managed Care Payer Contract 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, and ancillary payer agreements from a variety of sources including but not limited to commercial, governmental, specialty, and single case agreements.

This position has a focus on professional contracts across the organization, including some value based contracts.

Additional Information
Department Name: Managed Care
Job Status: Full time, 40 hours per week.
Shift: Day Monday to Friday 8am to 5pm

Duties & Responsibilities

* Negotiates and manages a portfolio of fee-for-service contracts with third party payers and other contracting entities, in conjunction with upline leadership, that optimizes revenue, margin and growth in alignment with strategic objectives.

* Serves as a member of various organizational committees and task forces, as appropriate; performs other responsibilities and projects at the direction of upline leadership.

* 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.

* Develops 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.

* Makes recommendations regarding participation or non-participation with new or existing agreements. Adheres to all established contracting language and financial guidelines and parameters.

* Assists 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.

* Represents the organization in establishing business relationships with payers. Utilize communication and organizational skills to work collaboratively and credibly with payers to achieve common objectives.

* Responds to third party payers, employers, internal staff and physicians in day-to-day customer service relations and problem resolution.

* Collaborates with operational departments, identifies and implements appropriate changes in operating procedures and systems that might be required to accommodate payer contracts.

* Delivers service to our internal and external customers by advocating for customer preferences; partnering with peers and customers while obtaining feedback.

Minimum Qualifications

• Degrees
  • Bachelor's degree in Business, Finance or Health Care Administration.
• Experience
  • Minimum Experience Required: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.
• Equivalency
  • In lieu of a Bachelor's degree, one year of professional experience will serve as an equivalency to one year of education.
• Licenses & Certifications
  • None
• Additional Requirements
  • Not Applicable
• Competency
  • None

Salary Information
Pay is dependent on applicant's relevant experience.

Annual Salary Range (Based on 40 hours worked per week): $97,718.13 to $146,577.20

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.