Provider Contract Specialist

Driscoll Children's Hospital•Corpus Christi, TX

About The Position

The Provider Contract Specialist, in conjunction with the Manager of Contracting and Provider Data Management, develops, monitors, and manages provider contracts for Medicaid, CHIP, and LTSS at Driscoll Health Plan. The role works with Provider Network Strategies, Provider Relations, Information Systems (Epic), and Claims to finalize and implement new contracts and amendments to existing contracts. Responsibilities include developing and managing contract templates, distributing contracts, coordinating and tracking execution, maintaining data integrity, communicating with providers about contracts, and storing and tracking executed contracts in accordance with applicable law. The position coordinates contract processing and execution, supports provider contract analysis and issue resolution, and maintains contract records and tracking systems. It also reviews contracts and related documents for compliance with regulatory, accreditation, and health plan requirements; monitors LTSS provider compliance with contract terms; conducts special studies or audits; coordinates office site visits; and prepares reports for leadership and senior management. Other reasonably related duties may be assigned.

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 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 on preparation, execution, distribution, and tracking of new and re-contracting agreements for Medicaid, CHIP, and LTSS providers.
Research provider, group, and facility legal names, required reimbursement methods, and TMHP enrollment status.
Ensure atypical LTSS providers are enrolled with HHSC when enrollment is requested.
Vet unlicensed or uncertified LTSS providers to confirm minimum credentialing requirements are met before contracting.
Coordinate distribution of executed contracts to internal departments, including Credentialing, Network Strategies, Claims, and Tapestry.
Serve as a provider contracting liaison, explain DHP contracting protocols, and respond to related questions and issues.
Assist with analysis and coordination of contract amendments, reimbursement changes, and language changes; request information needed to complete contract profiles in collaboration with the Manager.
Work with other departments to research and resolve contractual issues.
Maintain contracts and contract tracking systems, update contract information, review contract language, identify changes from current language, and maintain status logs.
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 against contract terms and maintain a mechanism for documenting compliance.
Perform special studies and audits and coordinate office site visits.
Develop reports for leadership and senior management about contract status, content, and other requested data in collaboration with the Manager.
Perform other duties as assigned to support departmental and organizational needs.