Senior Provider Contract Specialist

Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty 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 set-up 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 compliance

Additional Information:

Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty 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 set-up 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 compliance
Education:

• Bachelor's degree, with 5 years’ experience or Associate’s 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 in-depth knowledge of Medicaid and other reimbursement methodologies.

• Excellent written and verbal communication skills.

• Ability to manage multiple priorities in a fast-paced 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 Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region.  Cook Children's 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 Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.