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Specialist, Provider Contracts (Remote)
Molina Healthcare • Remote • Posted 29 days ago
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Remote • Full-time • $17.85-$38.69/hr • Mid Level
Job Highlights
Using AI ⚡ to summarize the original job post
Molina National Level Contracting jobs are responsible for the accurate and timely maintenance of critical provider information on all claims and provider databases. They synchronize data among multiple claims systems and apply business rules to each database, validating data to ensure adherence to business and system requirements. The role involves negotiating contracts, maintaining a tracking system, and participating in network development and evaluation.
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.
- Supports network development throughout state 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.
Qualifications
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.
- 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
- Bachelor's Degree
About Molina Healthcare
Molina Healthcare is a Fortune 500 managed care company operating in the United States. They offer Medicaid, Medicare, and Marketplace health plans, focusing on providing affordable, quality healthcare to underserved populations. The company has expanded through acquisitions, such as acquiring Magellan Complete Care to enter the Florida market and enhance their services.
Full Job Description
**JOB DESCRIPTION**
**Job Summary**
Molina National Level Contracting jobs are 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.
Pay Range: $17.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Molina National Level Contracting jobs are 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.
Pay Range: $17.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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