TX STAR+PLUS Network Operations ConsultantPrimary Location: Dallas, TX
Additional Locations: TX-Dallas, TX-Ennis, TX-Grand Prairie, TX-Greenville, TX-Irving, TX-McKinney, TX-Plano, TX-Terrell Apply
Reviews, analyzes, evaluates, and validates provider contracts. Supports contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial goals. Responsible for assisting in the reviewing, building and auditing complex contracts and network data, support recruitment efforts, and collaborate on negotiations as needed.
- Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
- Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
- Provides technical expertise for questions related to contracting and related systems and information contained.
- Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities.
- May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
- Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.
- May conduct or assist with service activities such as provider education, technology usage, or process updates.
- May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets.
- Interprets contractual requirements including federal and state regulations and NCQA.
- Participates in JOC meetings.
- Promotes and educate providers on cultural competency.
- Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation, and reimbursement modeling activities including credentialing.
- 3 years related experience.
- Knowledge of basic negotiating skills desired.
- Proven working knowledge of standard provider contracts, terms and language desired.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Bachelor’s Degree or equivalent combination of education and experience.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
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