Sr. Contracts Administrator - Payor Contracting & Relations - Houston, TX

 
Position: Sr. Contracts Administrator - Payor Contracting & Relations - Houston, TX

Job ID: 142378

Location: US-TX-Houston

Department: PAYER CONTRACTING & RELATIONS

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p M -F

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 hospital setting. In this position, you’ll be responsible for analysis, negotiation, and implementation of hospital and physician group contracts, letters of agreement (LOA), and single case agreements with commercial and Texas managed Medicaid health plans. In doing so, this position is responsible for developing and maintaining positive relationships with individuals at all levels of authority within each health plan, and the IDS, including CEOs, CFOs, and Vice Presidents. This position may interact with attorneys, directors, managers, and peers on a daily basis. This position is responsible for managing and completing major departmental projects including recommending project plans and recommending resource allocations.

 

Think you’ve got what it takes?

 



Responsibilities :

  • Negotiates high volume, hospital and physician group contracts 
  • Prepares and analyzes financial reports in support of hospital and physician group contracting initiatives 
  • Develops and maintains strategic relationships with IDS personnel and health plans at all levels of authority 
  • Assures compliance with regulatory requirements and product requirements related to provider contracting functions 
  • Assists in the development of contracting strategy for hospital and physician group initiatives 
  • Implements new health plan contracts 
  • Supports management through communication, ad hoc reporting and quality improvement initiatives

 

 



Qualifications:

  • Bachelor’s degree  
  • Five (5) years of applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role 
  • Knowledge of different reimbursement methodologies, including APR DRG, MS DRG, Per Diems, Capitation, OPPS, EAPGs and Percent of Charge.   Familiarity with Value Based Contracting methods, Clinical Integration and ACOs. 
  • Knowledge of industry regulations related to contracting and negotiation techniques, including knowledge of TDI and HHSC rules and regulations as they apply to the STAR & CHIP programs  
  • Knowledge of claims processes, medical management processes, medical terminology, and CPT coding  
  • Knowledge of CMS Medicare rules as may be appropriate 
  • Ability to review and negotiate hospital and physician provider contracts 
  • Ability to communicate effectively with internal staff and providers, and in regard to managed-care issues  
  • Proficiency in word processing, spreadsheet, and database software 
  • Strong organizational and follow-up skills

 

***MUST HAVE PREVIOUS MANAGED CARE HOSPITAL CONTRACTING EXPERIENCE FOR CONSIDERATION***

 

 

 

 

 



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