Network Hospital Contracting Specialist - Houston, TX (Healthcare)

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SUMMARY:

This individual reports directly to the Contracting Manager (Network Operations Senior Advisor) and will develop and maintain positive relationships with hospitals, ancillaries and other provider types within the provider network. Will also support the activities of the Network Operations Contracting Department, including: negotiating contracts and single case agreements, assisting and supporting the contractual and operational relationship with providers, coordinating provider data bases, credentialing, resolution of claims and appeals; assisting with the analysis of medical cost trends for providers.

Coverage Area: State of TX, Medicare and Medicaid licensed service areas

RESPONSIBILITIES:

Contracting and Credentialing Support

• Assist in coordinating provider agreements, amendments, and letters of agreement with non-contracted providers as needed by administrator and or director.
• Ensure copies of executed contracts or correspondence are returned to providers.
• Prepare contract packages, agreements and amendments for mailing to potential providers
• Coordinate, track and ensure credentialing process is complete for providers.
• Maintain provider file folders in master files and online databases

Coordinate Load Forms and Maintain Provider Data Bases  

• Complete and maintain departmental activity log
• Complete and load contract changes and rate terms for providers in TractManager and QNXT.  
• Assist in coordination of collection, compilation, and maintenance of data for HSD tables for internal, state, and CMS audits as well as any GEO Access Mapping
• Auditing of rate and demographic data to ensure system accuracy

Provider Orientations and Operational Meetings

• Organizes and conducts operating committee meetings with hospitals to include education on contracts, policies and procedures, financial trends and collaboration opportunities.
• Gather operational concerns expressed at operational meetings and work with Administrator or Director to resolve any operational issues. 
• Initiates and maintains effective channels of communication with providers, office staff and matrix partners.

Resolution of Claims and Operational issues with Providers

• Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve escalated and sensitive issues.
• Research and investigate provider concerns regarding claims payment, appeals, and resolution of operational issues. Coordinate with Claims department to research and resolve provider concerns.
• Respond to provider questions, phone calls, and inquiries in a timely fashion.

Analyze Outpatient Cost Reporting for Providers

• Assist in the analysis of monthly cost trends for the Texas Division.  
• Analyze, prepare, and review trend reports and detail by region for monthly presentations.
• Recommend solutions and assist in identifying action plans to remediate provider medical cost trends.

Other Duties and Responsibilities

• Participate in regularly scheduled meetings with other departments; offer substantive feedback to questions and research thoroughly any unknown issues.
• Be available during working hours to coworkers and others for questions; including multitasking on calls and other similar scenarios.
• Other duties and responsibilities as assigned

QUALIFICATIONS:

Bachelor's degree or equivalent, relevant work experience, required.

At least one year or more of work experience, preferred

Excellent presentation, communication and customer service skills required.  Excellent time management and relational skills.  Demonstrated analytical skills. Strong organizational abilities with attention to detail.

Computer Skills: Microsoft Word, Excel, PowerPoint

Qualified applicants will be considered without regard to race, color, age, disability, sex (including pregnancy), childbirth or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require an accommodation based on your physical or mental disability please email: SeeYourself@cigna.com. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.