Senior Provider Contract Specialist
Senior Provider Contract Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Location:
Calmont Operations BuildingDepartment:
Network MgmtShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
Coordinate and negotiate hospital physician (IPAs PPMs individual providers multispecialty groups) and ancillary service agreements that are in accordance with corporate health plan and State guidelines; Recruit and develop network for a region and set of providers; Lead assigned recruitments (i.e. physician hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives; Facilitate and oversee to the provider setup and contract configuration to ensure accurate claims adjudication; Initiate contact and identify potential providers by geographic and specialty needs and update database; Evaluate and monitor providers performance standards and financial performance of contracts; Develop contracting action plans; Coordinate with internal departments and contracted providers to implement and maintain contract complianceAdditional Information:
Education:
Bachelors degree with 5 years experience or Associates degree 10 years experience working with healthcare providers ancillary or hospital groups in a health plan setting preferred otherwise
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Proven contract preparation skills with an indepth knowledge ofMedicaidand other reimbursement methodologies
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fastpaced environment
Proficiency in MS Office applications
Experience working with healthcare providers ancillary or hospital groups
Experience working with Texas Medicaid
Preferred Qualifications:
Contracting Certification
Provider Relations experience
Experience with ACO/Risk Contracting
Value based contracting experience
CRM experience
Project Management experience/certification
About Us:
Cook Childrens Health Plan
Cook Childrens Health Plan provides vital coverage to nearly 120000 people in lowincome families who qualify for governmentsponsored programs in our six county service region. Cook Childrens Health Plan provides health coverage for CHIP CHIP Perinatal STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant Johnson Denton Parker Hood and Wise.
Cook Childrens is an EOE/AA Minority/Female/Disability/Veteran employer.
Required Experience:
Senior IC
Employment Type
Full-Time
