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Title:  Manager, Provider Support Services

Division:  Baylor MedCare
Schedule:  Monday-Friday; 8:00 a.m. -5:00 p.m.
Work Location:  Greenway Plaza, Houston, TX
Salary Range:  $61,913-$80,490
FLSA Status:  Exempt
Requisition ID:  3999
Summary

Manages the business development and managed care contract administrative services.

Job Purpose

Works closely with Director of Contract Administration to establish and maintain contractual relationships, identifies and acts on opportunities for administrative efficiency between BaylorMedCare and contracted managed care network.

Job Duties
  • Assist the Director in their HMO, PPO, POS contract negotiations for the College.  
  • Assume responsibility for some contract negotiations under the direct supervision of the Director.
  • Analyze impact of contract proposals, including detailed margin analysis of all assigned contract negotiations.
  • Supervises Medicare and Medicaid enrollment department for timely enrollment and revalidation for College faculty.
  • Supervises process of validating payment accuracy from contracted payers through Experian Contract Management software.
  • Anticipates educational needs and provides communication to Baylor College of Medicine clinical departments and Consolidated Business Organization (CBO) staff due to changes in contracts, marketplace or business needs.
  • Organizes health plan orientations and provides follow-up educational materials and tools.
  • Serves as resource for all managed care health plans in relation to operational policy and procedures, operating guidelines, and business practices.
  • Coordinates and leads monthly/quarterly joint operations meetings with contracted payers.
  • Recognizes potential areas of financial and operational improvement; coordinates training as needed to implement any needed changes.
  • Serves as primary contact for managed care health plans on issues of provider credentialing, enrollment and adherence to health plan guidelines and problem resolution.
  • Publishes and distributes periodic information bulletins pertaining to managed care business and professional updates.
  • Interacts with departmental leadership to identify problems/issues pertaining to implementation of managed care contracts.  
  • Serves as a resource to help resolve issues related to managed care contracts.
Minimum Qualifications
  • Bachelor's degree in a related field.
  • Four years of relevant experience. Degrees in lieu of experience will not be accepted.

 

 

 

 

Baylor College of Medicine is an Equal Opportunity/Affirmative Action/Equal Access Employer.

 3999

CA; CH