Medical Contracts Administrator
This is a contract position for a Medical Contracts Administrator.
As the Contract Administrator you will negotiate hospital contract language and rates, make recommendations to management regarding contracting strategy when contract proposals are not within Network Development, conduct financial analysis of claims data to develop rate proposals and to test reasonableness of all assumptions and develop alternative rate proposals in order to ensure performance of hospital contracts. Additional job duties are listed below:
- Understand & implement changes needed to ensure compliance with NCQA and regulatory requirements (UMCC & UMCM)
- Assist with implementation of new contracting database, Cobblestone, and ensure new agreement templates are available, process is implemented, dashboards and reports created, and P&Ps drafted for adherence to new processes
- Review and update all P&Ps to ensure compliance with NCQA, regulatory & organizational requirements
- Knowledge of industry regulations related to contracting, negotiation techniques including knowledge of TDI and HHSC rules and regulations as they apply to the STAR & CHIP programs, claims processes, medical management processes, medical terminology, and CPT coding.
- Ability to review and negotiate provider contracts and the ability to communicate effectively with internal staff, providers, and managed-care issues.
- Proficiency in word processing, spreadsheet, and database software.
- 4 years healthcare experience.
- Knowledge of NCQA, HHSC and TDI rules and regulations
- Overall healthcare knowledge of claims and medical management
- Required H.S. Diploma or GED
- Preferred Bachelor’s Degree
- Required 7 years applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role