Cook Children's Health Care System · 2 days ago
Senior Provider Contract Specialist
Fort Worth, TX
Full-time, Contract
Onsite
Senior Level
5+ years expCook Children's Health Care System is dedicated to providing essential health coverage to low-income families in their service region. They are seeking a Senior Provider Contract Specialist to coordinate and negotiate agreements with various healthcare providers, ensuring compliance with corporate and state guidelines while managing provider performance and contract compliance.
Hospital & Health Care
Responsibilities
Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines
Recruit and develop network for a region and set of providers
Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives
Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication
Initiate contact and identify potential providers by geographic and specialty needs and update database
Evaluate and monitor providers’ performance standards and financial performance of contracts
Develop contracting action plans
Coordinate with internal departments and contracted providers to implement and maintain contract compliance
Qualification
Required
Bachelor's degree, with 5 years' experience or Associate's degree, 10 years' experience working with healthcare providers, ancillary or hospital groups in a health plan setting preferred otherwise
Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
Proven contract preparation skills, with an in-depth knowledge of Medicaid and other reimbursement methodologies
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment
Proficiency in MS Office applications
Experience working with healthcare providers, ancillary or hospital groups
Experience working with Texas Medicaid
Preferred
Contracting Certification
Provider Relations experience
Experience with ACO/Risk Contracting
Value based contracting experience
CRM experience
Project Management experience/certification
Company
Cook Children's Health Care System
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Mike Simmons
President & CFO Cook Children's Home Health
Stephen Kimmel
Chief Financial Officer
Recent News
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