Managed Care Contracts Admin

 
Position: Managed Care Contracts Admin

Job ID: 159411

Location: US-TX-Houston

Department: PAYER CONTRACTING & RELATIONS

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a -5p Monday - Friday

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 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 Managed Care Contract Administrator -- someone who works well in a fast-paced setting. In this position, you will support the Managed Care Contracting staff in the development, negotiation, implementation, monitoring and management of managed care agreements. You will also assist in the research of managed care trends and be responsible for accurate and timely communication of terms that may impact reimbursement to the appropriate departments. This role also assists in the review and analysis of routine variance reports to specifically determine that contracts are performing in accordance with the terms.

 

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Responsibilities :

Job Duties & 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
  • Works closely with Senior Managed Care Contracts Administrator to review boilerplate contract documents from health plans
  • Prepares documentation as requested for successful completion of internal or external reviews, regulatory audits, or other contractual audits relating to contracting functions
  • Notifies contract load team of new fee schedules that need to be built and assures that fee schedules are loaded into system within 30 days of completed negotiations
  • Supports management through communication, ad hoc reporting, and quality improvement initiatives


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
  • 5 years hospital managed-care experience
  • Contracting, provider relations, or hospital business office experience required
  • Bachelor’s degree will substitute for four years of work experience
  • Master’s degree will substitute for two years of work experience

**Previous experience with Payor contracting highly preferred**



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