Senior Managed Care Contracts Administrator - Payor Contracting - Austin, Texas ***Fully Remote***

 
Position: Senior Managed Care Contracts Administrator - Payor Contracting - Austin, Texas ***Fully Remote***

Job ID: 164311

Location: US-Remote TX Based, US-TX-Austin

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

Texas Children’s Hospital has begun its expansion from Houston to Austin! We are excited about the opportunity to extend Texas Children’s mission to a large and growing population of children and women. Our Urgent Care opened in March 2018, several pediatric practices will open this spring and summer, and our first Specialty Care Center will open this October. The Specialty Care Center is located at 8611 North Mopac Expressway, approximately 8 miles north of downtown Austin near Highway 183 and will include these subspecialties and more: • Cardiology • Pulmonary Medicine • Neurology • Diabetes/Endocrinology • Gastroenterology • Dermatology • Allergy & Immunology • Urology • Ophthalmology • Plastic Surgery. Our robust, outpatient-focused approach includes a plan through 2021 for 18 pediatric practices, 4 urgent cares, 3 specialty care centers, and 2 maternal fetal medicine centers, all on 1 integrated medical record. Texas Children’s presence in Austin helps deliver regional coordination of care and is synergistic to the core services offered at our Texas Medical Center campus in Houston.   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

Summary:

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 :

SKILLS & 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**

**Experience with Value Based Methodologies highly preferred**



Qualifications:

QUALIFICATIONS

  • High School Diploma/GED
  • A minimum of nine (9) years of applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role
  • In lieu of a Bachelor’s degree, an additional four (4) years of related work experience is required
  • 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
  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption

**This will be a fully remote position.  Out of state applications welcomed**



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