The Director, Network Administration is a key leadership role in the management of the Network Administration Department at Community Health Choice with primary responsibilities for process management and improvement, reporting to regulatory bodies (HHSC, CMS, TDI) and management of delegated entities (pharmacy, behavioral health, vision and dental). Primary liaison with Claims and Contract Configuration Teams to ensure smooth flow of accurate information from Contracting and checks and balances between the processes of each department. Responsible for provider data audits and working with process owners to address deficiencies and subsequently working with the Performance Excellence department to improve related processes. Responsible for claims quality and claims audits including oversight of claims adjudication process of delegated entities. Works collaboratively with the Director of Contracting and Provider Relations to ensure proper training of Community personnel on interfaces between Contracting and other departments. Ongoing management of provider contract management system once implemented.
Bachelor's degree required; Master's preferred
Five years in health care experience preferably with contracts and/or Managed Care
Minimum three years management experience including project management experience
Above average verbal communication skills
Writing /Composing, Correspondence / Reports
MS Word, MS Excel
Internal Number: 145394
About Harris Health System
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.