The future is full of possibilities. At Banner Health, we're excited about what the future holds for health care. That's why we're changing the industry to make the experience the best it can be. Our team has come together with the common goal: Make health care easier, so life can be better. The future of health care starts here. If you're ready to change lives, we want to hear from you. Apply today.
The Managed Care Operations position negotiates and administers contracts between Managed Health Care Insurance Companies and Banner Health and Banner Health Network (Hospital, Transplants, Behavioral Health, Surgicenters, Home Health, etc.), as well as, participates in the development and implementation of contract management tools and processes to assist in achieving the organizations contracting objectives and strategies.
Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY This position administers contracts for the organization. This position participates in the development and implementation of contract management tools and processes to assist in achieving the organizations contracting objectives and strategies. In addition, this position provides leadership and training to Contracts Management Specialists. This position serves as a primary resource for complex and/or sensitive agreements, which may be assigned based on departmental need.
CORE FUNCTIONS 1. Conducts initial review of proposed contract language. Reviews and revises proposed contracts, ensuring compliance with company policy/guidelines and legal requirements. Assess business terms to be sure the contract supports the company/business unit goals. Works directly with vendors/payer to negotiate and resolve contract issues, preparing contract documents for approval and execution by appropriate company leader.
2. Drafts and reviews contracts or other related documents for execution by appropriate company leader. Verifies intent of proposed contract with internal and external customers (including company and vendor/payer legal counsel).
3. Serves as a resource for internal and external clients to interpret contract language and resolves contract issues by reviewing and interpreting contract terms and originating contract documentation.
4. Provides leadership and training to Contracts Management Specialists, including but not limited to reviewing and editing contract language in various documents, training new staff on essential department processes/communication flows, and serving as the primary resource for questions on complex and/or sensitive agreements.
5. Leads and/or completes special projects, develop processes improvements, and serve as a resource for complex contracts.
6. Possess the skillset required to assess the financial impact of potential and ongoing contracts and the interpersonal skills to interact effectively and efficiently with management, internal customers, third party and managed care payors, consultants and other outside agencies.
7. For assignments in managed care: Conducts analyses and compiles data for review of strategic contract terms for management review and decision making to specified areas of concern. Participates in contract monitoring and support tools (matrices), by reviewing and interpreting contracts, extracting key information for use by internal and/or external customers, and keeping abreast of changes in company locations for inclusion in various matrices. Maintains contract and correspondence file systems, key activity dates report (with corresponding notices of changes to external customers) and contract workflow log.
8. This position works independently, reviewing, writing and revising contract language. This position works with vendors or other payers to negotiate contracts which are within company policy/guidelines and legal requirements. Internally interfaces with all levels of company management. Externally interfaces with vendors or other payers.
Experience consistent with a Bachelor's degree in business, healthcare or related field required. Requires five plus years of legal experience preferably relating to contract drafting, preparation and analysis. Must possess demonstrated skill in problem analysis and resolution; contract management; oral and written communication. Requires highly developed interpersonal and listening skills. Must be able to function independently, possess demonstrated flexibility in multiple project management. Requires strong computer and database skills.
Must have a strong knowledge of healthcare industry financial indicators and an in depth understanding of Commercial, AHCCCS and CMS reimbursement methodologies.
Assignments in managed care require strong contract writing skills as well as patient financial claims systems knowledge
PREFERRED QUALIFICATIONS For assignments in Managed Care, specific managed care contract experience is highly preferred. Legal Assistant Certification from an American Board Association (ABA)-accredited school preferred.
Additional related education and/or experience preferred.
Internal Number: R1065
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.