Harris Health System

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Sr Contract Administrator

at Harris Health System

Posted: 3/1/2019
Job Status: Full Time
Job Reference #: 144282
Keywords:

Job Description

About Us

Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Profile

The Sr. Contract Administrator serves as the point of contact for all Third Party Administration (TPA) services provided to key client and negotiates or assists the Director of Contract Administration with negotiation and finalization of TPA service contracts and/or related downstream provider agreements.
The Sr. Contract Administrator collaborates with internal departments such as Compliance, Contracting, Provider Services, Configuration, Claims, Finance, Analytics, Legal Affairs, Medical Affairs, and Purchasing to ensure input into TPA agreements prior to execution for optimal administrative efficiency, as well as accurate implementation and on-going reporting.
Accountable for maintaining the relationship with TPA clients, ensuring contract compliance and resolution of various issues related to delegated services which may include, but are not limited to claims payment, invoice generation and payment receipt, Provider Access & Availability, Member/Provider complaints and data reporting.

QUALIFICATIONS:

  • Bachelor's Degree preferred but may substitute equivalent work experience for education. At least 2 years college training required.
  • Seven years in healthcare with at least five years of experience in Managed Care contracting, Provider Relations, or Third-Party Administration relations.


OTHER SKILLS:
Communication:

  • Above Average Verbal (Heavy Public Contact)
  • Writing/composing, Correspondence/ Reports
  • Analytical, Mathematics, Medical Terminology, P.C., Research, Statistical, Word Processing

Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Job Category

All Jobs

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!