Manager Contracting & Provider Data

20 Driscoll Children's Health Plan; Corpus Christi (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

Driscoll Health Plan is seeking a seasoned Manager of Contracting and Provider Data to lead the Contracting and Provider Data Management teams in ensuring accurate provider information across systems. You will develop policies, oversee audits, coach staff, and drive process improvements while collaborating with internal partners.

The role requires strong leadership, contract administration, data governance, and the ability to translate regulatory requirements into practical workflows within a

Qualifications

• Must have 3–5 years related experience in contracting or provider data management.
• Experience leading teams and driving process improvements.
• Understanding of Medicaid/health plan operations is a plus.

Responsibilities

• Lead daily activities of Contract and Provider Data Management teams.
• Develop and implement policies and procedures for provider contracts and data.
• Coach and monitor staff, review KPIs, and drive quality audits.
• Collaborate with internal partners to resolve data and contracting issues.
• Monitor regulatory updates and implement system changes accordingly.

Skills

Leadership

Contract management

Provider data governance

Quality improvement

Education

High school diploma or GED

Tools

Echo credentialing system

Tapestry system

Contract Management system

Job description

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below.

GENERAL PURPOSE OF JOB

The Manager of Contracting and Provider Data is responsible for the management and supervision of the daily activities of the Contract and Provider Data Management (PDM) teams, to administer DHP standardized provider contracts and ensure the accuracy of provider data within DHP’s systems. The position’s responsibilities include the development of operational policies and procedures, quality audit, coaching, training, monitoring of departmental key performance metrics, and implementation of process improvement initiatives. The position also provides technical and professional leadership to the department and to internal and external business partners.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.

• Maintain the highest level of confidentiality at all times.
• Adhere to DHS/DHP policies and procedures.
• Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Provide leadership for the Provider Contracting, Provider Data Management and Credentialing department, including but not limited to contract intake, change requests, standard contract administration, and provider data maintenance.
• Ensure contract requests are processed and implemented timely and accurately.
• Constantly monitor key performance metrics to monitor adherence with regulatory and internal requirements and identify opportunities for improvement.
• Adjust staff assignments, direction, and priorities to quickly respond to changing priorities and business needs.
• Ensure flexibility of the department through effective communication of business rationale and regulatory requirements, utilizing change management techniques and setting a positive attitude example.
• Collaborate with internal DHP partners to achieve resolution of contract and provider data issues and ensure best practices, including but not limited to Provider Relations, Claims Administration, Finance, Alternative Payment Management, Network Strategy, Utilization Management, and IT.
• Identify and manage risks, resolve conflicts, and remove barriers that impede the department’s ability to achieve goals and expectations.
• Develop, implement, monitor, and communicate performance goals and results to staff, engaging in appropriate coaching, development, and improvement action plans as needed.
• Manage the issue resolution process from identification to solution, ensure appropriate staff are engaged to resolve issues, ensure active collaboration with business partners as needed, and ensure issues of high risk are communicated and escalated appropriately.
• Develop and maintain an environment that encourages teamwork and communication and supports quality and process improvement suggestions and solutions.
• Monitor Texas Medicaid and Health Partnership (TMHP) and HHSC Bulletins and Notices to identify payment updates including fee schedule changes, SDA and encounter rate changes, and fee schedule updates; ensure the appropriate internal review is completed and submit change requests for system implementation of claims reimbursement.
• Manages routine quality audits of provider data in both the Echo credentialing system as well as the Tapestry system.
• Manage implementation and maintenance of applicable Contract Management system.
• Perform other related work as requested.

EDUCATION AND/OR EXPERIENCE

High school diploma or general education degree (GED); or Associate’s degree (A.A.) or equivalent from two-Year College or technical school; three to five years related experience and/or training; or equivalent combination of education and experience.

Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.