Provider Contracts Specialist

Molina Healthcare; Naperville (IL); Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated individual for provider network contracting roles. This position will involve negotiating contracts, maintaining critical provider information, and ensuring compliance with regulations. The ideal candidate will have experience in healthcare contract negotiation and a strong ability to communicate effectively with various stakeholders. Join a dynamic team committed to enhancing healthcare delivery and making a positive impact in the community. This role offers an opportunity to contribute to strategic network development and work collaboratively in a supportive environment.

Qualifications

• 2-4 years provider contract support or negotiation experience in healthcare.
• Strong communication skills to convey contract terms clearly.

Responsibilities

• Negotiate contracts and letters of agreements with providers.
• Maintain provider information on claims and databases accurately.
• Support network development and ensure adherence to adequacy standards.

Skills

Contract Negotiation

Provider Relations

Communication Skills

Data Validation

Education

Associate’s Degree in a related field

Bachelor’s Degree in a related field

Job description

***Remote and must live in Illinois***

Job Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.
Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception.

Executes standardized fee for service and other core payment method contracts with predefined, common programs. Typically does not entail heavy negotiations. Minimal ongoing engagement after contract.

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases.
Synchronizes data among multiple claims systems when applicable, and the 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.

Job Duties

1. This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures.
2. Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments, including but not limited to Fee for Service and Alternative Payment Methods including Pay for Performance.
3. Supports network development throughout state to including researching, recruiting and negotiating with providers.
4. Participates in the evaluation of provider network and implementation of strategic plans to meet Molina’s network adequacy standards.
5. Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
6. 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.
7. Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes.
8. Participates in other contracting related special projects as directed.
9. Travels regularly throughout designated regions to meet targeted needs.

Job Qualifications

REQUIRED EDUCATION:

Associate’s Degree in a related field or an equivalent combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

2 - 4 years provider contract support or 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 in a related field or an equivalent combination of education and experience

PREFERRED EXPERIENCE:

1-3 Years Managed Care experience

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

Pay Range: $20.83 - $40.62 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.