Contract Specialist - The Health Plan

 
Position: Contract Specialist - The Health Plan

Job ID: 152360

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

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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are looking for a Contract Specialist -- someone who works well in a fast-paced setting. In this position, you will be responsible for supporting network management by completing research projects, processing and implementing provider agreements and provider changes, and answering provider calls. This position is also responsible for managing and completing major departmental projects.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

  • Manages LOI process, prepares service forms for provider information and contract changes, works service flow queues for contract/application process
  • Monitors TMHP website for provider reimbursement changes on a monthly basis
  • Provides ongoing support to network management department and other internal customers as needed
  • Answers network management’s main provider phone line and triage/resolve provider issues
  • Submits required reports, ad hoc reports, and completed projects to management in a timely manner
  • Demonstrates proficiency with software applications that are necessary to complete assigned tasks including but not limited to call tracking system and claims payment system as well as word processing, spreadsheet, database, and graphics software products
  • Maintains all boilerplate contracts
  • Reviews Texas Department of Insurance regulations and Texas Department of Health regulations as contractual obligations and recommends amendments to boilerplate contracts as needed


Qualifications:

Skills & Requirements

  • High school diploma or GED required
  • Two years’ health care or managed healthcare experience required
  • Two years’ college coursework preferred


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