Managed Care - Sr Contracts Administrator - TCH Specialty Pharmacy - Houston, TX

 
Position: Managed Care - Sr Contracts Administrator - TCH Specialty Pharmacy - Houston, TX

Job ID: 144001

Location: US-TX-Houston

Department: PAYER CONTRACTING & RELATIONS

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Senior Contracts Administrator – someone who works well in a fast-paced setting. In this position, you’ll be responsible for analysis, negotiation, implementation, and development of contracts, agreements, and amendments with pharmacy benefit managers (PBM's).  In doing so, you will be responsible for developing and maintaining positive relationships with individuals at all levels of authority within each hospital system, including CEOs, CFO’s, and Vice Presidents. Lastly, you will be responsible for managing and completing major departmental projects including recommending project plans & recommending resource allocations.

 

Think you’ve got what it takes?



Responsibilities :

  • Negotiates hospital contract language and rates using established parameters/guidelines
  • Makes recommendations to management regarding contracting strategy when contract proposals are not within Network Development established parameters/guidelines
  • Conducts financial analysis of claims data to develop rate proposals and to test reasonableness of all assumptions
  • Evaluates hospital claims data to determine service lines which influence medical expenses
  • Monitors hospital claims data to identify opportunities for re-negotiation
  • Develops and maintains successful business relationships with participating hospitals
  • Documents visits with hospitals in call tracking system
  • Submits hospital visit reports in accordance with departmental policies and procedures
  • Demonstrates proficiency with Texas Department of Insurance regulations relating to hospital contracting
  • Demonstrates proficiency with product requirements relating to provider contracting
  • Recommends amendments to policies and procedures as needed in order to maintain compliance
  • Assists in the development of contracting strategy for high volume, strategic providers
  • Receives and reviews completed contracting documents from providers and forwards to credentialing department
  • Communicates provider trends to management and other parties as appropriate in a timely manner

ADDITIONAL RESPONSIBILITIES SPECIFIC TO THIS POSITION:

  • Develop or alter purchasing agreements between Texas Children’s Hospital and PBMs.
  • Act as a liaison between insurance providers, PBMs, and TCH’s general counsel.
  • Monitor, regularly review, and report financial and operational performance of contracts versus expectations, including annual pharmacy demographic updates.
  • Assist in the development and implementation of Texas Children’s strategies and objectives related to its Specialty Pharmacy.
  • Research and recommend contract policies and procedures to legal team and Specialty Pharmacy leadership.
  • Maintain database of contracts including key terms and conditions necessary for the proper administration of contracts.
  • Management of Pharmacy related contracts, and related credentialing, coordinating payer audits, and updates

 



Qualifications:

  • Bachelor’s degree
  • A minimum of seven (7) years of applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role
  • In lieu of a Bachelor’s degree, an additional four (4) years of related work experience is required
  • Knowledge of industry regulations related to contracting, negotiation techniques including knowledge of TDI and HHSC rules and regulations as they apply to the STAR & CHIP programs
  • Ability to review and negotiate provider contracts

HIGHLY PREFERRED:

  • Knowledge of medical and pharmacy benefits, payor and provider environment is highly preferred
  • Experience working or knowledge of HBS/SPARCS, RxClaim, HcN, or ACIS platforms desired


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