Provider Contracts Manager

About the role

We're searching for a Provider Contracts Manager who thrives in a fast-paced environment. In this position, you'll handle the analysis, completion, implementation, and ongoing follow-up of primary care, specialist, and ancillary provider contracts while developing and maintaining positive relationships with providers and internal customers. You'll interact daily with attorneys, directors, managers, and peers, and manage major departmental projects, including recommending project plans.

Responsibilities

• Identifies providers who are eligible for participation in the provider network and who meet network and member needs.
• Conducts face-to-face and telephonic outreach to providers to initiate and follow up on contracts and credentialing materials.
• Ensures the provider contracting process is conducted in accordance with departmental policies, procedures, and regulatory requirements.
• Reviews managed-care contracts and ensures language and rates are within established parameters and guidelines.
• Facilitates the credentialing process for new providers and ensures contracts are executed by both parties and filed appropriately.
• Serves as a subject matter expert for provider contract configuration within the claims payment system.
• Serves as a subject matter expert on provider contract templates and responds to requests for contract interpretation.
• Prepares documentation needed for RFPs, readiness reviews, regulatory audits, and other contractual audits.
• Develops and maintains standard pricing grids, fee schedule crosswalks, and reports to monitor contract performance.
• Attends weekly meetings with the manager to discuss the status of projects and contracting efforts.
• Communicates provider trends to management in a timely manner.
• Completes ad hoc reports and projects within assigned deadlines.

Requirements

• High school diploma or equivalent, required.
• 4 years of applicable healthcare experience in a contracting, provider relations, business development, or provider business office role, required.
• Bachelor’s degree, preferred (may substitute for a portion of the required experience).

About Us

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.