Provider Contract Specialist

20 Driscoll Children's Health Plan; Corpus Christi (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

Driscoll Health Plan is seeking a Contract Specialist to develop, monitor, and manage provider contracts for Medicaid, CHIP, and LTSS. You will coordinate contract execution, maintain templates, and ensure data integrity across multiple departments.

Ideal candidates will have 2+ years in healthcare contracting, an associate degree, and familiarity with LTSS enrollment and regulatory requirements. On-site role in Corpus Christi, TX with opportunities to collaborate across teams.

Qualifications

• Two years of healthcare provider contracting or related contracting experience.
• Minimum one year experience in healthcare provider relations, network management or related work.

Responsibilities

• Maintains confidentiality at all times.
• Coordinates receipt and processing for provider contracts and related documents.
• Collaborates on preparation, execution, distribution and tracking of new or re-contracting agreements.
• Researches legal names and enrollment status with TMHP as part of contracts.
• Ensures LTSS providers are enrolled with HHSC at enrollment time.
• Vetting to meet minimum credentialing for LTSS providers prior to contracting.
• Coordinates issuance of executed contracts with Credentialing, Network Strategies, Claims, and other departments.
• Lamiliar with contracting language and policy requirements to ensure compliance.

Skills

Contracting experience

Healthcare experience

Education

Associate degree

Bachelor's degree preferred

Job description

GENERAL PURPOSE OF JOB:

The Provider Contract Specialist, in conjunction with the Manager of Contracting and Provider Data Management, is responsible for developing, monitoring and managing provider contracts for Medicaid, CHIP and LTSS at Driscoll Health Plan. Working in collaboration with the Provider Network Strategies, Provider Relations, Information Systems (Epic), and Claims Departments, this position finalizes and implements new contracts as well as amendments to existing contracts. Responsible for development and management of contract templates, the distribution of provider contracts, coordination and tracking of contract execution, data integrity, provider communications related to contracts, and storage/tracking of executed contracts, in accord with applicable law.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Maintains utmost level of confidentiality at all times.
• Adheres to DHS/DHP policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Coordinates receipt and processing for all provider contracts, delegation agreements, letters of agreement (LOAs), termination notices, extension letters, etc.
• Collaborates in preparation, execution, distribution and tracking of all new or re-contracting agreements for Medicaid, CHIP and LTSS providers.
• Performs basic research to determine the legal names of provider/group/facility, reimbursement method required, as well as the status of the provider/group/facility with TMHP enrollment at time of request.
• Ensures the atypical LTSS providers are enrolled with HHSC at time of enrollment request.
• Performs vetting process to ensure minimum credentialing requirements for unlicensed or uncertified LTSS providers are met prior to contracting.
• Coordinates the issuance of all executed contracts to the appropriate parties with various internal departments such as Credentialing, Network Strategies, Claims, and Tapestry.
• Serves as the liaison for provider contracting, explaining fully the DHP protocols for contracting and responding to questions and/or related issues.
• Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile in collaboration with Manager.
• Collaborate with other departments as well as within own department to research and resolve contractual issues.
• Maintains contracts, including making changes and updates using various systems review contract language, compare and identify changes from current language. Maintains provider contract tracking system and maintains status logs.
• Manages multiple projects concurrently
• Conducts formal reviews of Contracts and associated documents for compliance with regulatory, accreditation and DHP policy requirements.
• Monitor activities of LTSS providers by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, and

EDUCATION AND/OR EXPERIENCE:

• Associate's degree (A. A.) or equivalent from two-year college in a related field.
• Bachelor's degree (B. A.) from four-year college or university preferred.
• Two years’ experience in health care provider contracting or related contracting experience.
• Minimum of one-year experience health care provider relations, network management/development, or related work experience within healthcare.
• Prior experience in managed care and LTSS (Long Term Services & Support) preferred coordinates office site visits.
• Develops reports for leadership and senior management related to contract status, content, and other data requested in collaboration with Manager.
• Performs other duties as assigned to facilitate departmental and organizational needs.

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.