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. If you're ready to change lives, we want to hear from you.
Reporting directly to Health Plan COO, this position will work along side Health Plan leaders and Senior leaders, to drive the Health Plan Value Based Purchasing strategy to the next level. We are a very collaborative team that works hard and has fun while we do it!
Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits 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.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package. Banner University Health Plans (BUHP) manage a variety of health plans. Our mission is to advance health and wellness through education, research and patient care. About Banner Health Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.
This position is responsible for the development of the provider network (physicians, hospitals, pharmacies, ancillary groups & facilities, etc.) 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 and ancillary providers, and ensuring the network composition includes an appropriate distribution of provider specialties. Also may be responsible for oversight of all credentialing functions, including credentialing processes for initial applications and reappointments for medical and allied health professional staff.
1. Develops goals and objectives for the BPHO network in accordance and alignment with company goals in collaboration with Sr. Director Network Management; provides leadership, measures and feedback, of departmental goals; ensures achievement of growth and development goals.
2. Leads the Provider Relations Representatives and/or Specialty Representative Teams and Monitors, analyzes and presents information regarding network performance, physician performance, provider engagement network adequacy, market needs, and competition and industry trends.
3. Analyzes network adequacy and determine network needs through measurement against standards and Health Network initiatives; Monitors feedback from member complaints, staff and network provider's feedback for indicators related to network adequacy and accessibility.
4. Develops and maintains positive provider relationships. Solicits and engages providers and vendors to build network relationships by demonstrating knowledge of providers in assigned geographic area. Researches problems and negotiates with providers and internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues as well as provider complaints. Responsible for interpreting, articulating and resolving contract servicing and reimbursement issues.
5. Develops and executes action plans promoting a sustained provider recruitment plan supporting the development of preferred relationships, increasingly aggressive rate negotiation, and strong education to operations teams.
6. 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.
7. Negotiates new contracts, amendments and renewing contracts in a highly competitive environment, including physicians, allied professionals, ancillary facility, pharmacy and behavioral agreements that are fiscally and responsible in the designated geographic area. Consults with and makes recommendations to BPHO/BHN staff in regular contract negotiations to ensure purpose, accuracy and profitability of reimbursement structure, identifying network needs to ensure availability and accessibility of providers to members.
8. Provides oversight of the credentialing process, ensuring that all initial applications and reappointments are processed in a timely and complete manner. Supervises the maintenance of required credentialing documentation, ensuring the consistency and integrity of all corresponding data housed in the credentialing database.
9. Ensures the continued growth and network adequacy of the Health Network with aligned providers, partners and vendors . Requires interactions with all levels of staff, management and physicians. Actions initiated by this position must be consistent with policies and procedures developed by the organization's insurance plan division, the provider relations department and the organization's network of physicians and hospitals. Operational provider relation issues are reviewed with and resolved through coordination with the Area Operations Director, as appropriate.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelor's degree in business, healthcare or related field.
Must possess a strong knowledge and understanding of healthcare planning and management as normally demonstrated through five or more years of managed care contracting and/or credentialing experience; demonstrated ability to provide leadership for a team and in developing/streamlining processes and strategies related to provider network development. 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.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
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 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.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.