Sr. Contracts Administrator - The Health Plan - Bellaire, TX

 
Position: Sr. Contracts Administrator - The Health Plan - Bellaire, TX

Job ID: 145558

Location: US-TX-Houston

Department: Contract Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

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.   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 managed care setting. In this position, you’ll be responsible for analysis, negotiation, and implementation of facility contracts.  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 :

Job Duties & 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


Qualifications:

Skills & Requirements

 

  • 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


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