JOB SUMMARY

Responsible for providing support for the provider contracting process. Organizes contract inventories and verifies that all required documents are received from providers and complete. Ensures all contract requests are submitted in internal systems, and to the appropriate Provider Contract Specialist or Senior Provider Contract Specialist within defined internal timeframe or regulatory requirement. Route signed provider contracts through defined approval process. Arrange and maintain information for network recruitment, inclusive of network adequacy requirements designated by regulatory agencies, which may include prospecting and outreach to prospective network providers. Following monthly MCMC meeting, forward Welcome Packet and executed agreement to providers within defined timeframe and submit to Payment Solutions team for loading. Ensure all provider files in pending status are followed up in a timely manner indicated in the departmental policy and procedure. Prepare provider termination forms, program adds, and demographic changes and submit to Payment Solutions within defined regulatory timeframes. Confirm quality and completeness of information in files (for example, W-9, contracts, correct effective dates etc.) and loaded in appropriate internal systems.

JOB SPECIFICATIONS AND CORE COMPETENCIES
Essential Functions

• Manage provider contracting workflow from initial intake to contract loading, including, but not limited to, collection of missing information, verification of complete application, sending welcome packets to providers.
• Prepare provider termination forms, program adds, and demographic changes and submit to Payment Solutions within defined regulatory timeframes.
• Serve as a liaison between Community and its providers, as appropriate, including acknowledging receipt of application packet, collecting missing information from application packet, status requests, and other provider inquiries.
• Arrange and maintain information for network recruitment, inclusive of network adequacy requirements designated by regulatory agencies, which may include prospecting and outreach to prospective network providers.
• Actively contribute to achievement of departmental goals, as identified in Department?s annual business plan, including specific departmental process improvement plans.
• Other duties as assigned.

MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure:

• High School Diploma or Equivalent required

Work Experience (Years and Area):

• 1 year relevant work experience required

Management Experience (Years and Area): N/A

Software Proficiencies:

• Microsoft Office (Word, Excel, Outlook) required

Other:

• Must Have Vehicle and Valid State of Texas Driver's License required
• Experience with Star Plus, LTSS, HCBPs, and Medicare products a plus preferred.