Provider Contracts Manager

TCH Medical Center; Bellaire (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

TCH Medical Center is seeking a Provider Contracts Manager to lead the analysis, execution and ongoing follow-up of provider contracts across primary care, specialist and ancillary services. The role emphasizes building positive relationships with providers and internal customers while coordinating with attorneys, directors and peers on major projects.

The successful candidate will manage contract templates, pricing grids and credentialing workflows, ensuring compliance with policies and timely

Qualifications

• High school diploma or equivalent, required.
• 4 years of health care contracting or related experience, required.
• Bachelor's degree, preferred.
• A bachelor's degree may substitute for part of the required experience.

Responsibilities

• Identifies providers who are eligible for participation in the provider network and 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

Health care contracting

Provider relations

Project management

Analytical thinking

Education

Bachelor's degree

Degree substitution allowed

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.

Think you've got what it takes?

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