Provider Contracts Manager

Texas Children's Medical Center; Bellaire (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

Texas Children's Medical Center in Bellaire, TX is seeking a Provider Contracts Manager to manage the analysis, completion, implementation and follow‑up of provider contracts across primary care, specialty and ancillary networks.

You will collaborate with attorneys, directors and managers to drive major projects, apply regulatory standards and maintain strong provider relationships.

Qualifications

• 4 years of applicable health care contracting experience.
• High school diploma required.
• Bachelor's degree preferred (may substitute for part of the experience)

Responsibilities

• Identifies providers eligible for network participation and meets member needs.
• Conducts outreach to providers to initiate and follow up on contracts and credentialing materials.
• Ensures contracting complies with departmental policies, procedures and regulatory requirements.
• Reviews managed-care contracts to ensure language and rates meet parameters and guidelines.
• Facilitates credentialing and ensures contracts are executed and filed.
• Serves as SME for provider contract configuration within the claims payment system.
• Responds to requests for contract interpretation.
• Prepares documentation for RFPs, readiness reviews and audits.
• Develops pricing grids, fee schedule crosswalks and reports to monitor performance.
• Attends weekly manager meetings to discuss project status.
• Communicates provider trends to management.
• Completes ad hoc reports and projects within deadlines.

Skills

Contracting experience

Provider relations

Regulatory compliance

Communication

Education

High school diploma

Bachelor's degree

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