Contract Manager HMO Providers (Health Plan) Job

Children's Health - HMO Careers

Job Number: 52198

Location: Dallas, TX

Date Posted: 9-11-2017

Description:

POSITION SUMMARY:

Responsible for negotiating and re-negotiating physician, hospital and ancillary provider contracts on behalf of Children's Medical Center Health Plan and all provider affiliates, in accordance with company standards, in order to maintain and enhance provider networks (Medicaid, Commercial and Medicare Advantage) while meeting and exceeding accessibility, quality and financial goals.

JOB PROFILE:

  • Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field.
  • Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands and the factors that differentiate the organization in the market.
  • Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements.
  • Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information.
  • Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies.
  • Works independently, receives minimal guidance.
  • Explains difficult or sensitive information; works to build consensus.

JOB SPECIFIC RESPONSIBILITIES:

  • Negotiates contract language and reimbursement methodology to achieve financial and contractual advantage.
  • Knowledge of State and Federal laws and regulations pertaining to providers and provider agreements and specifically as a resource in regard to the UMCM, UMCC and TMHP guidelines.
  • Facilitates sharing of information internally as it relates to MCO updates, changes, contracts. This will be done via written and verbal communication.
  • Manages and leads projects assigned to network management, ensuring accurate and timely completion.
  • Identifies and implements opportunities to improve contract performance, including but not limited to enhanced reimbursement, reduction in denials and underpayments, contracting for new services.

QUALIFICATIONS:

Experience:

  • Minimum 5 years of experience in Managed Care, either from provider or managed care company, or a combination of both is required.
  • Minimum 2 years of experience with Texas Medicaid.
  • Minimum 3 years of experience with contract negotiations is required.
  • Progressive contracting experience; at least 3 years with contract negotiations in required.
  • Proven experience negotiating Medicaid, LTSS preferred, contracting reimbursement methodologies with complex hospital systems and large physician groups.
  • Extensive provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development.
  • Excellent written and verbal communication skills and experience presenting to varied audiences.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Knowledge of Microsoft Office applications.

Education:

  • Bachelors degree or 3 years’ experience negotiating provider contracts in lieu of degree.

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