This position is responsible for the management of provider contracting yielding a geographically competitive, broad access, stable network that achieves objectives for unit cost performance and trend management. Responsible for establishing and maintaining strong business relationships with Hospital, Physician, Pharmacy, or Ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Manages the activities of the Managed Care Banner Health and Banner Health Network contracting employees including contract creation, contract follow-up, problem resolution, review of potential provider candidates, contract auditing and contracting activities to support Banner Health and Banner Health Network.
Directs personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations. Develops work goals and objectives for the department in accordance and alignment with company goals; provides leadership, measures and feedback, and motivation for staff achievement of departmental goals ensuring timely completion of work flow in order to meet regulatory compliance and departmental turn-around time.
Monitors, analyzes and presents information regarding network performance, market needs, and competition and industry trends to management team.
Assures contracts are executed timely to maintain network adequacy. Monitors feedback from internal groups, providers and staff related to network adequacy and accessibility so network meets contracting needs and decreases potential out-of-network utilization.
Maintains positive provider relationships through personal and in-person discussions. Solicits and engages providers and vendors by responding and resolving issues related to providers who contract with Banner Health and Banner Health Network. Understand interrelationships among providers and Banner Health/Banner Health Networks needs in local market and presents recommendations regarding territory needs, looking always to expand the network to support profitable market growth via contracting.
Reviews numerous contract documents in great detail with high level of comprehension and retention. Evaluates proposed payment methodologies as requested by providers as the initial first step in evaluating a need for a new contract or an amendment to an existing contract. Responsible for identifying unprofitable contracts for renegotiation.
Negotiates highly complex new contracts, amendments, value-based purchasing amendments and renewing contracts in a highly competitive environment, including physicians, allied professionals, ancillary facility, pharmacy and behavioral health agreements that are fiscally and responsible in the designated geographic area. Oversees and supervises staff in daily contract negotiations to ensure purpose, accuracy and profitability of reimbursement structure, identifying network needs to ensure availability and accessibility of providers to members.
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, healthcare or related field.
Must possess a strong knowledge and understanding of healthcare planning and management as normally demonstrated through seven or more years of managed care contracting experience and a demonstrated ability to provide leadership for a team and in developing/streamlining processes. Provider relations experience required.
This position requires a thorough knowledge of managed care and governmental reimbursement methodologies, the ability to analyze financial ramifications of decisions, excellent interpersonal skills and exceptional organizational abilities. Must be able to communicate effectively with others by speaking, reading, and writing. Relies on extensive experience and judgment to plan and accomplish goals.
A master's degree is highly preferred.A preferred requirement of this position is a thorough knowledge of Medicare, Medicaid, and ALTCS policies and procedures.
Additional related education and/or experience preferred.
Internal Number: 259705
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.