Provider Contracts Specialist

Job Description

***Remote and must live in California***

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

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. Contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and Joint operating Committees on exception.