Provider Contract Specialist

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

The Provider Contract Specialist works in conjunction with the Manager of Contracting and Provider Data Management to develop, monitor, and manage provider contracts for Medicaid, CHIP, and LTSS at Driscoll Health Plan. The role collaborates with Provider Network Strategies, Provider Relations, Information Systems (Epic), and Claims to finalize and implement new contracts and amendments to existing contracts. It is responsible for developing and managing contract templates; distributing provider contracts; coordinating and tracking contract execution; maintaining data integrity; communicating with providers about contracts; and storing and tracking executed contracts in accordance with applicable law. The specialist coordinates provider contracting activities and serves as a liaison for provider contracting, explaining Driscoll Health Plan protocols and responding to related questions and issues. The role also reviews contracts and associated documents for compliance, monitors specified LTSS provider contract terms, tracks contract status, and prepares reports for leadership and senior management. Employees may also perform other reasonably related duties assigned by their supervisor or Health Plan administration.

Requirements

Associate's degree or equivalent from a two-year college in a related field.
Two years of experience in health care provider contracting or related contracting experience.
At least one year of experience in health care provider relations, network management/development, or related work within healthcare.

Nice To Haves

Bachelor's degree from a four-year college or university.
Prior experience in managed care and LTSS (Long Term Services & Support).

Responsibilities

Maintain confidentiality and adhere to DHS/DHP policies, ethical business practices, and corporate compliance and integrity guidelines.
Coordinate receipt and processing of provider contracts, delegation agreements, letters of agreement, termination notices, extension letters, and related documents.
Collaborate in preparing, executing, distributing, and tracking new and re-contracting agreements for Medicaid, CHIP, and LTSS providers.
Research provider, group, or facility legal names, required reimbursement methods, and TMHP enrollment status at the time of request.
Ensure atypical LTSS providers are enrolled with HHSC when an enrollment request is made.
Vet unlicensed or uncertified LTSS providers to ensure they meet minimum credentialing requirements before contracting.
Coordinate distribution of executed contracts to relevant internal departments, including Credentialing, Network Strategies, Claims, and Tapestry.
Serve as the provider contracting liaison, explain DHP contracting protocols, and respond to questions and related issues.
Assist with analysis and coordination of contract amendments, reimbursement, and language changes; request billing codes, service details, and other information needed to complete contract profiles in collaboration with the Manager.
Collaborate with other departments to research and resolve contractual issues.
Maintain provider contracts, make changes and updates using relevant systems, review contract language, and identify changes from current language.
Maintain the provider contract tracking system and status logs, and manage multiple projects concurrently.
Conduct formal reviews of contracts and associated documents for compliance with regulatory, accreditation, and DHP policy requirements.
Monitor LTSS provider activities by tracking contract-specific terms and documenting compliance; conduct special studies or audits and coordinate office site visits.
Develop reports for leadership and senior management on contract status, content, and other requested data in collaboration with the Manager.
Perform other duties as assigned to meet departmental and organizational needs.