Managed Care Reporting & Contracts Specialist

Epic Healthcare; Culver City (CA); On-site; USD 95,000 - 135,000; Full time

Job summary

Epic Healthcare in Culver City, CA is seeking a Managed Care Reporting & Contracts Specialist to oversee reporting, contracting, credentialing, and audits across MCPs and Medi‑Cal programs. You will coordinate with finance, operations, and leadership to ensure accurate data, timely submissions, and compliant processes.

The role requires strong Excel skills, attention to detail, and the ability to manage multiple deadlines while communicating effectively with external MCPs and internal teams.

Qualifications

• Experience in managed care, health plan operations, revenue cycle, quality, or similar healthcare environment.
• Strong working knowledge of Medi-Cal managed care, preferably with ECM, Community Supports, or similar programs.
• Demonstrated experience preparing complex recurring reports and submitting via portals or secure file transfer systems.
• High proficiency with Excel and other spreadsheet tools.
• Exceptional attention to detail and accuracy in data handling.
• Strong organizational skills with the ability to manage multiple deadlines and shifting priorities.
• Clear, professional written and verbal communication with County and MCP representatives and internal leaders.

Responsibilities

• Own the end-to-end production and submission of recurring County and MCP reports.
• Attend information sessions, sometimes in-person, to stay on top of developments.
• Maintain reporting calendars and trackers to ensure all reports are delivered on or before deadlines.
• Coordinate with internal departments to obtain accurate census and clinical/operational data for each report.
• Review, validate, and clean data prior to submission to minimize rejections and correction cycles.
• Submit reports through MCP portals and secure file transfer platforms according to plan specs.
• Manage correction files and return transmissions from MCPs and resubmit within required timelines.
• Track status of County and MCP contracts and lines of business by region.
• Prepare LOIs and provider information forms for new contracts and program expansions.
• Coordinate credentialing and certification process with MCPs, including collecting documents and timelines.
• Manage annual re-credentialing for all contracted MCPs.
• Support tax ID and NPI updates with MCPs and vendors.
• Submit County and MCP capacity reports and maintain provider directories.
• Monitor MCP surveys and network status checks in coordination with leadership.
• Coordinate and respond to audits and compliance documentation.
• Support with staff background verification and compliance requests.
• Monitor shared MCP inboxes and route authorizations and notices.
• Escalate urgent items to leadership and follow up until resolved.
• Assist with grants, special projects, and hospital reporting.

Skills

Excel proficiency

Data analysis

Communication skills

Organization

Attention to detail

Tools

Excel

Job description

Job Title: Managed Care Reporting & Contracts Specialist
Department: Operations / Managed Care Programs
Reports To: Director of Finance

Overview:

The Managed Care Reporting & Contracts Specialist is responsible for maintaining
Horizon's relationships and compliance with Counties and Medi-Cal Managed Care Plans (MCPs)
across various CalAIM services, such as Recuperative Care and Enhanced Care Management
(ECM). This role oversees all reporting, credentialing and re-credentialing, audits, and contract
status tracking.

Key Responsibilities

1. MCP Reporting & Data Management

• Own the end-to-end production and submission of recurring County and MCP reports
• Attend information sessions, sometimes in-person, to stay on top of developments
• Maintain reporting calendars and internal trackers to ensure all reports are delivered on
  or before deadlines.
• Coordinate with internal departments and staff to obtain accurate census and
  clinical/operational data for each report.
• Review, validate, and clean data prior to submission to minimize rejections and
  correction cycles.
• Upload and submit reports through MCP portals and secure file transfer platforms
  according to each plan’s specifications
• Manage and respond to correction files and return transmissions from MCPs,
  coordinating revisions with internal staff and resubmitting within required timelines.

2. MCP Contracting, LOI & Credentialing

• Track the status of all County and MCP contracts and lines of business and by region
• Prepare, complete, and submit Letters of Interest (LOIs), provider information forms,
  and certification packets for new contracts and program expansions.
• Coordinate the full credentialing and certification process with MCPs, including:
  o Collecting required documents
  o Submitting policies and procedures as requested
  o Tracking timelines from LOI to certification to contract execution
• Manage annual re-credentialing for all contracted MCPs.
• Support tax ID and NPI updates with MCPs and vendors to avoid service or billing
  interruptions.

3. Capacity, Network Status & Surveys

• Complete and submit County and MCP capacity reports for various lines of business.
• Maintain up-to-date information for MCP provider directories, including locations,
  capacity, and service offerings.
• Monitor and respond to MCP surveys, network status checks, and directory attestations
  in coordination with leadership.

4. Audits, Compliance & Quality Assurance

• Coordinate and respond to County, MCP, and internal audits
• Support random MCP audits of patient information by gathering requested
  documentation
• Assist with background verification and compliance documentation requested for staff
• Ensure all submissions and communications adhere to MCP, Medi-Cal, and contractual
  requirements.

5. Managed Care Communications & Authorizations Support

• Monitor shared MCP email inboxes.
• Route authorizations, notices, and requests to the appropriate internal teams and track
  follow through as needed.
• Escalate urgent or complex items to leadership and follow up until resolved.

6. Grants, Special Projects & Hospital/Partner Reporting

• Support grant-related tasks such as researching opportunities, tracking deadlines, and
  assisting with application components as assigned.
• Assist leadership with surveys, special projects, and requests from health systems and
  hospitals.
• Maintain organized documentation of pending items and follow ups.

7. Team Leadership & Collaboration

• Provide day-to-day oversight, training, and quality review for reporting assistant(s)
  who populate templates and perform initial data entry.
• Standardize workflows and documentation so tasks can be handed off, trained, and
  scaled as the organization grows.
• Collaborate closely with operations, billing, admissions, program managers, and
  executive leadership to ensure alignment between MCP requirements and internal
  processes.
• Participate in recurring MCP and internal operations meetings as the primary point
  person for contracts and reporting.

Qualifications:

Required:

• Experience in managed care, health plan operations, revenue cycle, quality, or similar
  healthcare environment.
• Strong working knowledge of Medi-Cal managed care, preferably with exposure to
  ECM, Community Supports, or similar value-based programs.
• Demonstrated experience preparing complex recurring reports and submitting via
  portals or secure file transfer systems.
• High proficiency with Excel and other spreadsheet tools.
• Exceptional attention to detail and accuracy in data handling.
• Strong organizational skills with the ability to manage multiple deadlines and shifting
  priorities at once.
• Clear, professional, written, and verbal communication skills with the ability to
  interface directly with County and MCP representatives and internal leaders.

Preferred:

• Prior experience working with California MCPs such as LA Care, HealthNet, Molina,
  Blue Shield, CHG, or Kaiser.
• Familiarity with electronic health record systems such as PCC.
• Experience in Recuperative Care, ECM, homeless services, Housing Navigation, or
  post-acute/community-based care.
• Prior experience in contract management, credentialing, or network management.
• Experience supervising or mentoring staff in an operation or reporting function.