Healthcare Provider Contract Network Specialist

Job Description:
Performs targeted recruitment to close network adequacy gaps for Medicare / Medicaid on behalf of Molina Healthcare of Virginia. This position is 100% remote. Work hours will be M-F 8:00-5:00 PM EST.

Must have experience contracting and negotiating provider contracts using Preferred, Acceptable, Discouraged, Unacceptable (PADU) guidelines.
• Evaluates provider network and implement strategic plans with the goal of meeting network adequacy standards.
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.

Must Have Skills:
• Network development / contracting experience in managed care
• Recruiting experience for health plans / closing for network adequacy
• Staying within PADU contracting guidelines
• Recruiting for Medicaid / Medicare
• Ability to update spreadsheets / word templates

Day to Day Responsibilities:
• Make outbound calls and emails following up on targeted providers for closing network gaps related to network adequacy
• Work with business analyst, network director for confidence on getting applications back in-house for submission to HSD filing for CMS filing
• Complete the exception request template with necessary data elements from CMS

Required Years of Experience:
• 5-7 years contract-related experience in the health care field including, but not limited to, provider’s office, managed care organization, or other health care environment.
• 3 years’ experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, group and hospital contracting, etc.
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to: Value Based Payment, fee-for service, capitation and various forms of risk, ASO, etc.

Required Licensure / Education: Bachelor’s Degree in a healthcare related field or an equivalent combination of education and experience.