Manager, Provider Contracts

Molina Healthcare; Long Beach (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

Molina Healthcare is seeking a National Level Contracting professional to manage provider information across claims systems. The role involves developing contracting strategies, preparing contracts, and ensuring compliance with regulations. Ideal candidates will have a Bachelor's degree and 5-7 years of relevant experience.

Benefits

Competitive benefits and compensation package

Qualifications

• 5-7 years of experience in provider contracting.
• Experience with healthcare provider contracts and compliance.

Responsibilities

• Maintain critical provider information and synchronize data among claims systems.
• Develop health plan-specific provider contracting strategies.
• Prepare provider contracts according to company guidelines.

Skills

Contracting Strategies

Cost Control Strategies

Compliance

Education

Bachelor's Degree in Business Administration

Graduate Degree

Job description

***Remote and must live in Georgia***

Job Description

Job Summary
Molina National Level Contracting jobs are responsible for the accurate and timely maintenance of critical provider information on all claims and provider databases. They maintain critical provider information, synchronize data among multiple claims systems, and apply business rules as they pertain to each database. They validate data to ensure adherence to business and system requirements related to contracting, network management, and credentialing.

Knowledge/Skills/Abilities

• Develop health plan-specific provider contracting strategies with the Director, Provider Contracts, focusing on specialties and geographic locations to establish a sufficient network of Participating Providers.
• Prepare provider contracts in accordance with company guidelines with physicians, hospitals, MLTSS, and other healthcare providers.
• Assist in achieving annual savings through recontracting initiatives and implement cost control strategies to positively influence the Medical Care Ratio (MCR).
• Utilize standardized contract templates and Pay for Performance strategies.
• Use established Reimbursement Tolerance Parameters and oversee the development of new reimbursement models in collaboration with the Director.
• Maintain all Provider and payer Contract Templates, working with legal and Corporate Network Management to ensure compliance with contractual and regulatory requirements.
• Ensure compliance with provider panel and network capacity, adequacy requirements, and guidelines by producing and monitoring relevant reports.
• Develop and implement strategies to minimize the company's financial exposure, monitoring and adjusting strategies as needed.

Job Qualifications

Required Education
Bachelor's Degree in a related field (e.g., Business Administration) or equivalent experience
Required Experience
5-7 years
Preferred Education
Graduate degree

To all current Molina employees: If interested in applying, please do so 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.