Senior Managed Care Contracts Administration - Payer Contracting & Relations

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
• Maintains positive relationships with individuals at all levels of authority within each hospital system, including CEOs, CFO’s, and Vice Presidents
• Manages and completes major departmental projects including recommending project plans & recommending resource allocations
• 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
• Aids in the development of contracting strategy for high volume, strategic providers
• Communicates provider trends to management and other parties as appropriate in a timely manner

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

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 since 1954. We are proud to be an equal opportunity employer.