Be an early applicantLess than 25 applicantsPosted by Agency

Company

Molina Healthcare · 20 hours ago

Sr Specialist, Provider Contracts HP (Remote in MI)

Michigan, United States

Full-time

Remote

Mid Level

$23.76/hr - $51.49/hr

4+ years exp

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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

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

ContractingManaged CareProvider Network DevelopmentContract Management SoftwareCertified Recovery Peer SpecialistData ValidationProvider Recruitment

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

Preferred

Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.

Certified Recovery Peer Specialist certification required in the state of Florida

Benefits

Competitive benefits and compensation package

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10,001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)