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Senior Specialist, Provider Contracts

Company: Molina Healthcare
Location: Council Bluffs
Posted on: January 25, 2023

Job Description:

JOB DESCRIPTION ***Remote and must live in Iowa**** 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.
  • 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 EMPTORIS - contract management software.
  • Assists Manager and/or Director in the completion of Block Transfer Filings
  • Facilitates and resolves claim and configuration issues with impacted departments.
  • Participates in other contracting related special projects as directed.
  • 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.
  • Communicates proactively with other departments to ensure effective and efficient business results.
  • Trains and monitors newly hired Contract Specialist(s).
  • Participates in other contracting related special projects as directed. 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 5+ years previous experience in contracting with large specialty or multispecialty provider groups. Preferred Education Bachelor's Degree Preferred Experience Knowledge of integrated delivery systems, hospitals, and groups (specialty and ancillary) contracts highly desirable. #PJHPO 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: - $26.41 - $51.49 an hour* - *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level

Keywords: Molina Healthcare, Council Bluffs , Senior Specialist, Provider Contracts, Other , Council Bluffs, Iowa

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