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Molina Healthcare · 9 hours ago

Senior Provider Contracts Specialist

United States

Full-time

Remote

Mid, Senior Level

$26.41/hr - $51.49/hr

4+ years exp

Molina Healthcare is seeking a Senior Provider Contracts Specialist to manage network strategy and development, ensuring compliance with regulations and maintaining critical provider information. The role involves negotiating contracts with providers, maintaining network adequacy, and supporting network development throughout the state.

Health CareHospitalMedical

Responsibilities

Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments, including but not limited to Fee for Service and Alternative Payment Methods including Pay for Performance

Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting

Identified as contract system lead by developing and maintaining provider contracts in contract management software

Supports network development throughout state to including researching, recruiting and negotiating with providers

Participates in the evaluation of provider network and implementation of strategic plans to meet Molina’s network adequacy standards

Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers

Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile

Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes

Assists Manager and/or Director in the completion of Block Transfer Filings

Communicates proactively with other departments in order to ensure effective and efficient business results

Trains and monitors newly hired Contract Specialist(s)

Participates in other contracting related special projects as directed

Travels regularly throughout designated regions to meet targeted needs

Qualification

Contracting experienceManaged Care experienceProvider network developmentContract management softwareTraining skillsAnalytical skillsCommunication skillsTeam collaborationProblem-solving skills

Required

Bachelor's Degree or equivalent work experience in health care field including, but not limited to, provider's office, managed care, or other health care field

4-6 years previous experience in contracting with large specialty or multispecialty provider groups

1-3 Years Managed Care experience