Contracts Administrator - The Health Plan

 
Position: Contracts Administrator - The Health Plan

Job ID: 149654

Location: US-TX-Bellaire

Department: Contract Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Contracts Administrator — someone who works well in a fast-paced managed care setting. In this position, you'll be responsible for the analysis, implementation, completion and ongoing follow-up of various managed-care contracts for entities in our integrated delivery system. You will assist in developing and maintaining effective relationships with payors and internal customers. You may interact with attorneys, executive staff, directors, managers, and peers daily. You will be accountable for managing and completing major departmental projects including recommending project plans.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

 

  • Reviews managed-care contracts for language and rate appropriateness using the Network Development established parameters and guidelines
  • Ensures managed-care agreements are signed by both payor and hospital representative and that any newly-executed contracts are sent to Administrative Assistant for filing
  • Assists payors in resolving managed-care issues related to various entities of the integrated delivery system
  • Responds to internal staff requests regarding contract interpretation within 24 hours
  • Develops and maintains tools to assist various entities of the integrated delivery system in review and monitoring of managed-care contract performance and marketing of services
  • Attends meetings with other internal entities and departments, as needed, to discuss issues related to managed care
  • Acts as in-house contracting representative responding to payor and internal requests

 



Qualifications:

Skills & Requirements

 

  • High school diploma or GED required
  • 9 years of experience in managed-care
  • Experience in contracting or provider relations preferred
  • Bachelor’s degree preferred and may substitute for 4 years of experience

 



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