Managed Care - Sr Contracts Administrator - TCH Specialty Pharmacy

Confidential Company  •  Houston, TX

8 - 10 years experience  •  Business Services

Salary depends on experience
Posted on 10/10/17
Confidential Company
Houston, TX
8 - 10 years experience
Business Services
Salary depends on experience
Posted on 10/10/17

Responsibilities :

  • Negotiates hospital contractlanguage and rates using established parameters/guidelines
  • Makes recommendations to management regarding contracting strategy when contract proposals are not within Network Development established parameters/guidelines
  • Conducts financial analysis of claims data to develop rate proposals and to test reasonableness of all assumptions
  • Evaluates hospital claims data to determine service lines which influence medical expenses
  • Monitors hospital claims data to identify opportunities for re-negotiation
  • Develops and maintains successful business relationships with participating hospitals
  • Documents visits with hospitals in call tracking system
  • Submits hospital visit reports in accordance with departmental policies and procedures
  • Demonstrates proficiency with Texas Department of Insurance regulations relating to hospital contracting
  • Demonstrates proficiency with product requirements relating to provider contracting
  • Recommends amendments to policies and procedures as needed in order to maintain compliance
  • Assists in the development of contracting strategy for high volume, strategic providers
  • Receives and reviews completed contracting documents from providers and forwards to credentialing department
  • Communicates provider trends to management and other parties as appropriate in a timely manner


  • Develop or alter purchasing agreements between Texas Children’s Hospital and PBMs.
  • Act as a liaison between insurance providers, PBMs, and TCH’s general counsel.
  • Monitor, regularly review, and reportfinancial and operational performance of contracts versus expectations, including annual pharmacy demographic updates.
  • Assist in the development and implementation of Texas Children’s strategies and objectives related to its Specialty Pharmacy.
  • Research and recommend contract policies and procedures to legal team and Specialty Pharmacy leadership.
  • Maintain database of contracts including key terms and conditions necessary for the proper administration of contracts.
  • Management of Pharmacy related contracts, and related credentialing, coordinating payer audits, and updates



  • Bachelor’s degree
  • A minimum of seven (7) years of applicable hospital managed-care experience, in a facility contracting, provider relations, or hospital business office role
  • In lieu of a Bachelor’s degree, an additional four (4) years of related work experience is required
  • Knowledge of industry regulations related to contracting, negotiation techniques including knowledge of TDI and HHSC rules and regulations as they apply to the STAR & CHIP programs
  • Ability to review and negotiate provider contracts


  • Knowledge of medical and pharmacy benefits, payor and provider environment is highly preferred
  • Experience working or knowledge of HBS/SPARCS, RxClaim, HcN, or ACIS platforms desired

Job ID: 144001

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