Specialist, Provider Contracts (Remote)
About the position
The Specialist, Provider Contracts position at Passport Health Plan by Molina Healthcare is a critical role focused on the accurate and timely maintenance of essential provider information across various claims and provider databases. This position is integral to ensuring that the data housed within these systems adheres to business and system requirements, particularly in relation to contracting, network management, and credentialing. The Specialist will be responsible for synchronizing data among multiple claims systems and applying relevant business rules to each database. This role requires a keen attention to detail and a strong understanding of the healthcare landscape, particularly in provider relations and contract management. In this role, the Specialist will negotiate contracts and letters of agreements with hospitals, physician groups, and ancillary providers, ensuring that these agreements result in high-quality, cost-effective, and marketable provider options. The Specialist will maintain a tracking system for contracts and publish reports in accordance with departmental procedures. This includes initiating, negotiating, generating, and tracking provider Letters of Agreement, contracts, and amendments from the initial draft to full execution, utilizing approved standardized templates. The Specialist will also support network development throughout the state by researching, recruiting, and negotiating with providers. Participation in the evaluation of the provider network and the implementation of strategic plans to meet Molina's network adequacy standards is essential. Clear and professional communication of contract terms, payment structures, and reimbursement rates to various stakeholders, including physicians and hospitals, is a key responsibility. Additionally, the Specialist will assist in the analysis and coordination of amendments, reimbursement, and language changes, ensuring that all necessary information is gathered to complete the contract profile efficiently. Regular travel throughout designated regions may be required to meet targeted needs.
Responsibilities
Maintain critical provider information on all claims and provider databases.
,
Synchronize data among multiple claims systems and apply business rules as they pertain to each database.
,
Validate data to ensure adherence to business and system requirements related to contracting, network management, and credentialing.
,
Negotiate assigned contracts and letters of agreements with hospitals, physician groups, and ancillary providers.
,
Maintain a tracking system and publish reports according to departmental procedures.
,
Initiate, negotiate, generate, and track provider Letters of Agreement, contracts, and amendments from initial draft to full execution.
,
Support network development by researching, recruiting, and negotiating with providers.
,
Participate in the evaluation of the provider network and implement strategic plans to meet network adequacy standards.
,
Communicate contract terms, payment structures, and reimbursement rates clearly and professionally to stakeholders.
,
Assist in the analysis and coordination of amendments, reimbursement, and language changes.
,
Coordinate preparation and routing distribution of documents to complete the contracting process in a timely manner.
Requirements
Bachelor's Degree or equivalent work experience in the healthcare field, including provider's office or managed care.
,
3 - 5 years of provider contract negotiation experience in the healthcare field.
Nice-to-haves
Bachelor's Degree (preferred)
Benefits
Medical Insurance
,
Dental Insurance
,
Vision Insurance
,
Group & Voluntary Life Insurance
,
Aflac
,
Pet Health Insurance
,
Identity Theft Protection
,
Auto & Home Insurance
,
Flexible Spending Accounts
,
401K and Roth 401K
,
Employee Stock Purchase Plan
,
Continuing Education Units
,
Education Reimbursement
,
Paid Time Off
,
Volunteer Time Off
,
Company Holidays
,
Legal Assistance Plan
,
Employee Assistance & Well Being Programs
,
Employee Perks Platform
,
Rideshare Portal
Apply Now
The Specialist, Provider Contracts position at Passport Health Plan by Molina Healthcare is a critical role focused on the accurate and timely maintenance of essential provider information across various claims and provider databases. This position is integral to ensuring that the data housed within these systems adheres to business and system requirements, particularly in relation to contracting, network management, and credentialing. The Specialist will be responsible for synchronizing data among multiple claims systems and applying relevant business rules to each database. This role requires a keen attention to detail and a strong understanding of the healthcare landscape, particularly in provider relations and contract management. In this role, the Specialist will negotiate contracts and letters of agreements with hospitals, physician groups, and ancillary providers, ensuring that these agreements result in high-quality, cost-effective, and marketable provider options. The Specialist will maintain a tracking system for contracts and publish reports in accordance with departmental procedures. This includes initiating, negotiating, generating, and tracking provider Letters of Agreement, contracts, and amendments from the initial draft to full execution, utilizing approved standardized templates. The Specialist will also support network development throughout the state by researching, recruiting, and negotiating with providers. Participation in the evaluation of the provider network and the implementation of strategic plans to meet Molina's network adequacy standards is essential. Clear and professional communication of contract terms, payment structures, and reimbursement rates to various stakeholders, including physicians and hospitals, is a key responsibility. Additionally, the Specialist will assist in the analysis and coordination of amendments, reimbursement, and language changes, ensuring that all necessary information is gathered to complete the contract profile efficiently. Regular travel throughout designated regions may be required to meet targeted needs.
Responsibilities
Maintain critical provider information on all claims and provider databases.
,
Synchronize data among multiple claims systems and apply business rules as they pertain to each database.
,
Validate data to ensure adherence to business and system requirements related to contracting, network management, and credentialing.
,
Negotiate assigned contracts and letters of agreements with hospitals, physician groups, and ancillary providers.
,
Maintain a tracking system and publish reports according to departmental procedures.
,
Initiate, negotiate, generate, and track provider Letters of Agreement, contracts, and amendments from initial draft to full execution.
,
Support network development by researching, recruiting, and negotiating with providers.
,
Participate in the evaluation of the provider network and implement strategic plans to meet network adequacy standards.
,
Communicate contract terms, payment structures, and reimbursement rates clearly and professionally to stakeholders.
,
Assist in the analysis and coordination of amendments, reimbursement, and language changes.
,
Coordinate preparation and routing distribution of documents to complete the contracting process in a timely manner.
Requirements
Bachelor's Degree or equivalent work experience in the healthcare field, including provider's office or managed care.
,
3 - 5 years of provider contract negotiation experience in the healthcare field.
Nice-to-haves
Bachelor's Degree (preferred)
Benefits
Medical Insurance
,
Dental Insurance
,
Vision Insurance
,
Group & Voluntary Life Insurance
,
Aflac
,
Pet Health Insurance
,
Identity Theft Protection
,
Auto & Home Insurance
,
Flexible Spending Accounts
,
401K and Roth 401K
,
Employee Stock Purchase Plan
,
Continuing Education Units
,
Education Reimbursement
,
Paid Time Off
,
Volunteer Time Off
,
Company Holidays
,
Legal Assistance Plan
,
Employee Assistance & Well Being Programs
,
Employee Perks Platform
,
Rideshare Portal
Apply Now