The Senior Manager of Contracting will provide support to the Director of Contracting by assuring that Community achieves and maintains regulatory and accreditation compliance, as well as competitiveness, of its Provider networks for all lines of business (Medicaid/STAR, CHIP/CHIP Perinatal, Health Insurance Marketplace and others as determined by Community). This position is also responsible for contracting/re-contracting efforts or special projects, including but not limited to single case agreements, amendments, and service or product/program expansion. Manages and coordinates with all Community departments to ensure adequate set up and comprehensive interpretation of new contract fees and requirements. Assists with provider profiling, working closely with Finance, Analytics, Provider Relations, Member Services, Claims, and Medical Affairs to provide reports, assist with analysis and recommend actions. Requests, reviews, and analyzes 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. Manages and helps mentor the staff that negotiate/maintain physician, hospital, ancillary and integrated health system contracts.
MINIMUM QUALIFICATIONS:
1. Education/Specialized Training/Licensure: BA/BS Preferred. 4 years equivalent work experience may substitute for degree requirement.
2. Work Experience (Years and Area): 5+ years in the following areas: managed care with at least 3 years experience in contracting with physicians, ancillaries, hospitals. Experience in value based contracting a plus.
3. Management Experience (Years and Area): Minimum 3+ years
4. Equipment Operated: Computer, fax, scanners, MS Office, company-specific systems
SPECIAL REQUIREMENTS:
Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing, Correspondence Reports
Other Skills:
Analytical , Medical Terms, Statistical, P.C. , MS Word, MS Excel
Advanced Education: Bachelor?s Degree Major: BA/BS Preferred
Work Schedule: Flexible
Other Requirements: Must have car and valid Texas Drivers license.Must have medical contract negotations experience, preferably in Houston market.
RESPONSIBLE TO: Director
EMPLOYEES SUPERVISED: Clerical, Service