Contracts Administrator - The Health Plan

 
Position: Contracts Administrator - The Health Plan

Job ID: 159302

Location: US-TX-Houston

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.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.  

Summary:

We are searching for a Contracts Administrator — someone who works well in a fast-paced 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.

 

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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:

Being fully vaccinated against COVID-19 is required for all employees at Texas Children’s, unless approved for a medical or religious exemption

 

Skills & Requirements

 

  • High school diploma or GED required
  • 4 years of applicable healthcare experience in a contracting, provider relations, business development or provider business office role
  • Experience in contracting or provider relations preferred
  • Bachelor’s degree preferred and may substitute for 4 years of experience


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