Provider Contracts Manager

Texas Children's Hospital; Bellaire (TX); On-site; USD 95,000 - 140,000; Full time

Job summary

Texas Children's Hospital is seeking a Provider Contracts Manager to lead analysis, completion, implementation and follow-up of provider contracts across primary care, specialty and ancillary services.

You will work closely with attorneys, directors and managers to manage major projects, develop pricing grids and ensure timely contract execution and compliance with policies.

Qualifications

• High school diploma or equivalent is required.
• 4 years of health care contracting experience is required.
• Bachelor's degree is preferred; degree may substitute for some experience.

Responsibilities

• Identifies providers eligible for network participation and alignment with needs.
• Conducts outreach to providers to initiate and follow up on contracts and credentialing materials.
• Ensures contracting processes comply with departmental policies, procedures and regulatory requirements.
• Reviews managed-care contracts to ensure language and rates meet established parameters.
• Facilitates credentialing for new providers and ensures contracts are executed and filed.
• Prepares documentation for RFPs, readiness reviews and regulatory audits.

Skills

Contract analysis

Provider relations

Regulatory compliance

Project coordination

Communication skills

Education

High school diploma or equivalent

Bachelor's degree preferred

Job description

Job Description

We're searching for a Provider Contracts Manager, someone who works well in a fast-paced setting. In this position, you'll handle the analysis, completion, implementation and ongoing follow-up of primary care, specialist and ancillary provider contracts, while developing and maintaining positive relationships with providers and internal customers. You'll interact daily with attorneys, directors, managers and peers, and will manage and complete major departmental projects, including recommending project plans.

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Job Duties & Responsibilities

• Identifies providers who are eligible for participation in the provider network and who meet network and member needs
• Conducts face-to-face and telephonic outreach to providers to initiate and follow up on contracts and credentialing materials
• Ensures the provider contracting process is conducted in accordance with departmental policies, procedures and regulatory requirements
• Reviews managed-care contracts and ensures language and rates are within established parameters and guidelines
• Facilitates the credentialing process for new providers and ensures contracts are executed by both parties and filed appropriately
• Serves as a subject matter expert for provider contract configuration within the claims payment system
• Serves as a subject matter expert on provider contract templates and responds to requests for contract interpretation
• Prepares documentation needed for RFPs, readiness reviews, regulatory audits and other contractual audits
• Develops and maintains standard pricing grids, fee schedule crosswalks and reports to monitor contract performance
• Attends weekly meetings with the manager to discuss the status of projects and contracting efforts
• Communicates provider trends to management in a timely manner
• Completes ad hoc reports and projects within assigned deadlines

Skills & Qualifications

• High school diploma or equivalent, required
• 4 years of applicable health care experience in a contracting, provider relations, business development or provider business office role, required
• Bachelor's degree, preferred
• A bachelor's degree may substitute for a portion of the required experience

About Us

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.