Manager Contracting & Provider Data

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

The Manager of Contracting and Provider Data is responsible for the management and supervision of the daily activities of the Contract and Provider Data Management (PDM) teams. This role administers DHP standardized provider contracts and ensures the accuracy of provider data within DHP’s systems. Responsibilities include developing operational policies and procedures, quality audit, coaching, training, monitoring departmental key performance metrics, and implementing process improvement initiatives. The position also provides technical and professional leadership to the department and to internal and external business partners.

Requirements

High school diploma or general education degree (GED); or Associate’s degree (A.A.) or equivalent from two-Year College or technical school; three to five years related experience and/or training; or equivalent combination of education and experience.

Responsibilities

Maintain the highest level of confidentiality at all times.
Adhere to DHS/DHP policies and procedures.
Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Provide leadership for the Provider Contracting, Provider Data Management and Credentialing department, including but not limited to contract intake, change requests, standard contract administration, and provider data maintenance.
Ensure contract requests are processed and implemented timely and accurately.
Constantly monitor key performance metrics to monitor adherence with regulatory and internal requirements and identify opportunities for improvement.
Adjust staff assignments, direction, and priorities to quickly respond to changing priorities and business needs.
Ensure flexibility of the department through effective communication of business rationale and regulatory requirements, utilizing change management techniques and setting a positive attitude example.
Collaborate with internal DHP partners to achieve resolution of contract and provider data issues and ensure best practices, including but not limited to Provider Relations, Claims Administration, Finance, Alternative Payment Management, Network Strategy, Utilization Management, and IT.
Identify and manage risks, resolve conflicts, and remove barriers that impede the department’s ability to achieve goals and expectations.
Develop, implement, monitor, and communicate performance goals and results to staff, engaging in appropriate coaching, development, and improvement action plans as needed.
Manage the issue resolution process from identification to solution, ensure appropriate staff are engaged to resolve issues, ensure active collaboration with business partners as needed, and ensure issues of high risk are communicated and escalated appropriately.
Develop and maintain an environment that encourages teamwork and communication and supports quality and process improvement suggestions and solutions.
Monitor Texas Medicaid and Health Partnership (TMHP) and HHSC Bulletins and Notices to identify payment updates including fee schedule changes, SDA and encounter rate changes, and fee schedule updates; ensure the appropriate internal review is completed and submit change requests for system implementation of claims reimbursement.
Manages routine quality audits of provider data in both the Echo credentialing system as well as the Tapestry system.
Manage implementation and maintenance of applicable Contract Management system.
Perform other related work as requested.