Provider Contract Specialist - Commuity Health Choice
Harris Health System
Location: Houston, Texas
Type: Full Time
Internal Number: 162293
JOB SUMMARY: Responsible for network development; negotiating, monitoring and managing the contractual relationship of assigned provider contracts. Working in coordination with Compliance, Provider Relations and Network Management, negotiates and finalizes provider contract language and rates, including amendments for existing contracts and establishment of new ones. Contracts for physician, hospital, ancillary and delegation of services for Medicaid and any other programs CHC may develop. Responsible for Provider contract compliance. Coordinates with Network Management, Claims and Health Services to ensure adequate set up and comprehensive interpretation of new contract fees and requirements. Assists with provider profiling, working closely with Finance, Provider Relations, Member Services, Health Analysis and Health Services to provide reports, assist with analysis and recommend actions. Reviews quantitative analysis of various types of data including provider contracts, fee schedules, utilization and claims data needed for assessing, planning, budgeting, cost control and contract administration and makes recommendations for contracting rates and policies.
Education/Specialized Training/Licensure: Bachelor's degree in Marketing, business or related field; may substitute experience for education.
Work Experience (Years and Area): Five plus ( 5+) years in a health plan, with at least three (3) years experience Providers / Managed Care, Contracting and Relations.
Equipment Operated: PC and own transportation
1. Communication Skills: Above Average Verbal (Heavy Public Contact) Writing /Composing (Correspondence / Reports ) 2. Other Skills: Analytical Medical Terms Statistical P.C. MS Word MS Excel 3. Advanced Education: 4. Work Schedule: Flexible 5. Other Requirements: Must have car and valid Texas Drivers license. Must have managed contract negotiation experience, preferably in Houston market.
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.