Senior Managed Care Contracts Administration - Payer Contracting & Relations

Job Description

We are searching for a Senior Contracts Administrator - someone who works well in a fast-paced setting. In this position, you'll be responsible for analysis, negotiation, implementation, and development of contracts, agreements, and amendments with commercial and Texas managed Medicaid health plans, inclusive of Hospitals, Physicians, and Ancillary Services. In doing so, you will be responsible for developing and maintaining positive relationships with individuals at all levels of authority within each hospital system, including CEOs, CFO's, and Vice Presidents. Lastly, you will be responsible for managing and completing major departmental projects including recommending project plans & recommending resource allocations.

Think you've got what it takes?

Responsibilities
• Negotiates high volume, hospital and physician group contract language and rates using established parameters/guidelines
• Makes recommendations to management regarding contracting strategy when contract proposals are not within Network Development established parameters/guidelines
• Conducts financial analysis of claims data to develop rate proposals and to test reasonableness of all assumptions
• Evaluates hospital claims data to determine service lines which influence medical expenses
• Monitors hospital claims data to identify opportunities for re-negotiation
• Develops and maintains successful business relationships with participating hospitals
• Documents visits with hospitals in call tracking system
• Submits hospital visit reports in accordance with departmental policies and procedures
• Demonstrates proficiency with Texas Department of Insurance regulations relating to hospital contracting
• Demonstrates proficiency with product requirements relating to provider contracting
• Recommends amendments to policies and procedures as needed in order to maintain compliance
• Assists in the development of contracting strategy for high volume, strategic providers
• Receives and reviews completed contracting documents from providers and forwards to credentialing department
• Communicates provider trends to management and other parties as appropriate in a timely manner
**Experience with Hospital and/or Physician contracting highly preferred**

Skills & Qualifications
• High School Diploma/GED
• A minimum of five (5) years of applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role
• Knowledge of industry regulations related to contracting, negotiation techniques including knowledge of TDI and HHSC rules and regulations as they apply to the STAR & CHIP programs
• Ability to review and negotiate provider contracts

About Us

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 Tower 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; Texas Children's Hospital The Woodlands, the first hospital devoted to children's care for communities north of Houston; and Texas Children's Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children's Health Plan, the nation's first HMO focused on children; Texas Children's Pediatrics, the largest pediatric primary care network in the country; Texas Children's Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children's Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

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.