Senior Provider Contract Specialist

Cook Children's Health Care System; Fort Worth, Town of Texas, New York (TX, WI, NY); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Network Manager to coordinate and negotiate agreements with hospitals and providers. This role involves developing a robust network, ensuring compliance with contracts, and collaborating with various departments. The ideal candidate will possess strong financial acumen and excellent communication skills, thriving in a fast-paced environment. Join a mission-driven organization that provides vital health coverage to low-income families and make a meaningful impact in the community.

Qualifications

• 5+ years' experience with healthcare providers in a health plan setting.
• Strong financial skills and proficiency in analyzing financial trends.

Responsibilities

• Coordinate and negotiate provider agreements in line with guidelines.
• Monitor provider performance and financial outcomes of contracts.

Skills

Financial Analysis

Contract Preparation

Communication Skills

Project Management

Provider Relations

Education

Bachelor's Degree

Associate's Degree

Tools

MS Office

CRM Software

Job description

Location:

Calmont Operations Building
Department: Network Management
Shift: First Shift (United States of America)
Standard Weekly Hours: 40
Summary: Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups), and ancillary service agreements in accordance with corporate, health plan, and state guidelines. Recruit and develop a network of providers for a specific region. Lead recruitments for physicians, hospitals, and ancillary providers, ensuring contracts are complete, accurate, and meet objectives. Oversee provider setup and contract configuration for accurate claims adjudication. Identify potential providers based on geographic and specialty needs and maintain the database. Monitor provider performance and the financial outcomes of contracts. Develop contracting action plans. Collaborate with internal departments and providers to ensure contract compliance.
Additional Information:
Education:

• Bachelor's degree with 5 years' experience or Associate's degree with 10 years' experience working with healthcare providers, ancillary, or hospital groups in a health plan setting.
• Strong financial skills with proficiency in analyzing financial trends in provider contracting.
• Proven skills in contract preparation with knowledge of Medicaid and other reimbursement methods.
• Excellent communication skills, both written and verbal.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications.
• Experience working with healthcare providers, ancillary, or hospital groups.
• Experience with Texas Medicaid.

Preferred Qualifications:

• Contracting Certification.
• Provider Relations experience.
• Experience with ACO/Risk Contracting.
• Value-based contracting experience.
• CRM experience.
• Project Management experience or certification.

About Us:
Cook Children's Health Plan provides vital coverage to nearly 120,000 individuals in low-income families qualifying for government-sponsored programs within six counties: Tarrant, Johnson, Denton, Parker, Hood, and Wise. We offer health coverage for CHIP, CHIP Perinatal, STAR (Medicaid), and STAR Kids members. Cook Children's is an Equal Opportunity Employer, welcoming Minority/Female/Disability/Veteran applicants.