Provider Contracts Specialist

Job Description

***Remote and must live in Idaho or Utah***

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. 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.

KNOWLEDGE/SKILLS/ABILITIES

Negotiates assigned contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures.

• Initiates, negotiates, generates, and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments.
• 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.
• Travels regularly throughout designated regions to meet targeted needs.

JOB QUALIFICATIONS

Required Education

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.

Required Experience

3 - 5 years provider contract negotiation experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care field.

Preferred Education

Bachelor's Degree

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Info

Job Identification: 2024734

Job Category: Network Management

Posting Date: 2024-03-05T17:36:33 00:00

Job Schedule: Full time