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Healthcare Contract Specialist
hace 1 mes
Molina National Level Contracting jobs are responsible for maintaining accurate and timely provider information on all claims and provider databases. The role involves synchronizing data among multiple claims systems and applying business rules to each database. The Specialist, Provider Contracts will validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management, and credentialing.
Key Responsibilities:- Negotiates assigned contracts and letters of agreement with hospitals, physician groups, and ancillary providers to result in high-quality, cost-effective, and marketable providers.
- Maintains tracking systems and publishes reports according to departmental procedures.
- Initiates, negotiates, generates, and tracks provider Letters of Agreement, contracts, and amendments from initial draft to full execution using approved standardized contract templates/amendments.
- Supports network development throughout the state, including researching, recruiting, and negotiating with providers.
- Participates in the evaluation of provider networks 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 on billing codes, services provided, and other information needed to complete the contract profile.
- Coordinates preparation and routing of documents to complete the contracting process in a timely and thorough manner according to standardized processes.
- Travels regularly throughout designated regions to meet targeted needs.
- Bachelor's Degree or equivalent work experience in the healthcare field, including but not limited to, provider's office, managed care, or other healthcare field.
- 3-5 years of provider contract negotiation experience in the healthcare field, including but not limited to, provider's office, managed care organization, or other healthcare field.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
