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.
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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
