Manager of Contract Implementation (Health Plan Contracts)

 
Position: Manager of Contract Implementation (Health Plan Contracts)

Job ID: 148666

Location: US-TX-Bellaire

Department: Contract Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8am-5pm

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 Contract Implementation Manager — someone who works well in a fast-paced setting. In this position, you'll manage and maintain procedures supporting the rules and regulations as set by all regulatory entities to ensure timely processing of contracting information meeting all regulatory requirements including timeframes, documentation, and communication with providers.  Medicaid experience is a must!

 

Think you’ve got what it takes?



Responsibilities :

  • Supervises staff responsible for the processing of the contracting information including ensuring all contract documentation is processed within state guidelines, communicating with providers of needed or missing contract documentation to ensure timely processing, working with internal departments to coordinate the completion of the contracting process, and communicating with providers’ updates and/or status of their application and contract
  • Maintains procedures to ensure that all providers are properly credentialed and contracted prior to being effective, and ensures providers are notified of their effective date
  • Acts as an internal liaison for the organization to resolve managed care issues, contract implementation, contract interpretation, and maintain positive relationships with providers throughout the contracting process
  • Represents etwork Management at various meetings, both internal and external
  • Responsible for the oversight of responding to provider requests to join the provider network timely and in a consistent manner
  • Oversees timely submission of the HHSC report due quarterly
  • Ensures timely review and response to all calls, faxes, and emails received to the Network Management email and phone queue
  • Oversees documentation of all calls for internal department review and access as needed
  • Assures compliance with all regulatory and accreditation rules and regulations as they relate to network accessibility, professional services, and coordinate responses to Texas Health and Human Services provider complaints with claims director, business systems assistant director, and Provider Relations
  • Ensures compliance with State and Federal guidelines in timely submissions of various required reporting including Annual Open Enrollment, Delegation Amendments, Provider Directories, GeoMapping Reporting and Special Exception reports
  • Ensures timely processing of provider additions, changes, and terminations assigned to the Network Management Department and communicate status of those updates to internal departments and providers
  • Creates and maintains audit tools to monitor staff productivity, work quality, and accuracy


Qualifications:

  • Bachelor's Degree
  • Four (4) years of experience in health care, managed care, or contracts is required
  • Knowledge of managed care industry, cultural competence, rules and regulations that affect a HMO in the state of Texas including clean claims laws, rules and regulations
  • Ability to be an effective communicator to a broad spectrum of employees and providers


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