Payer Contract Manager

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 our doors.

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.

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.

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

• 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.

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.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.
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 collaboratively and credibly with payers to achieve common objectives.
7.Responds to third party payers, employers, internal staff and physicians in day-to-day customer service relations and problem resolution.
8.Collaborates with operational departments, identifies and implements appropriate changes in operating procedures and systems that might be required to accommodate payer contracts.
9.Delivers service to our internal and external customers by advocating for customer preferences; partnering with peers and customers while obtaining feedback.
10.Serves as a member of various organizational committees and task forces, as appropriate; performs other responsibilities and projects at the direction of the Director.

SCOPE AND LEVEL

Guidelines: Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent.

Complexity: Falls between the entry and full performance or senior level. Duties assigned are complex and of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects.

Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.

Communications: Contacts with the public or employees where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function.

Supervision Received: Performs work with minimal supervisory oversight or detailed instruction. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work product is subject to continual review.

Ability to Perform Essential Functions of the Job

PHYSICAL REQUIREMENTS

Audio-Visual: Far Vision: Good

Audio-Visual: Hearing: Good

WORK ENVIRONMENT

Mental and Emotional Requirements: Independent discretion/decision making.

Mental and Emotional Requirements: Manages stress appropriately.

Mental and Emotional Requirements: Works with others effectively.

Mental and Emotional Stress: Managing workload and system issues

Mental Stress: multi-tasking, meeting deadlines, prioritizing.

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.

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.