What are the responsibilities and job description for the Senior Provider Contracts Specialist (Remote in MI) position at Molina Healthcare Group?
Job Description
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 accurate and timely maintenance of critical provider information on all claims and provider databases. Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception. Able to execute 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. 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.
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/KNOWLEDGE, SKILLS & ABILITIES:
PREFERRED EXPERIENCE:
Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Certified Recovery Peer Specialist certification required in the state of Florida
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.
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Job Info
Job Identification: 2029018
Job Category: Network Management
Posting Date: 2024-11-13T20:49:17 00:00
Job Schedule: Full time