Provider Contracts Specialist

4 weeks ago

New York, United States Molina Healthcare Full time

***Remote and must live in New York***

JOB SUMMARY :

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and 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:

Negotiates assigned contracts for physician groups and ancillary providers that result in high quality, cost effective and marketable providers. Maintains tracking system andpublish reports according to departmental procedures.

• Initiates, negotiates, generates contracts and amendments from initial draft to full executionutilizing approved standardized contract templates/amendments.

• AssistsManager and/or Director in the negotiation of medical group/IPA.

• Facilitates and resolves claim and configuration issues with impacted departments.

• Participates in other contracting related special projects as directed.

• Supportsnetwork development throughout state to includingresearching, recruiting and negotiating with providers.

• Participates in the evaluation of provider networkand implementation of strategic plans to meet

Molina’s networkadequacy standards.

• Clearly and professionally communicates contractterms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.

• Assistsin analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes,services provided and other information needed to completethe contract profile.

• Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes.

• Communicates proactively with other departments in order to ensure effective and efficient business results.

• Participates in other contracting related special projects as directed.


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:

5+ years previous experience in contracting with large specialty or multispecialty provider groups.

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

 

PREFERRED EDUCATION:

Bachelor's Degree

PREFERRED EXPERIENCE:

Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: STATE SPECIFIC REQUIREMENTS:

 

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which thereis only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

 

 

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.

#PJCorp

Pay Range: $17.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

  • Senior Provider Contracting Specialist

    2 months ago

    New Port Richey, United States MASC Medical Full time

    Job DescriptionJob DescriptionPosition: Senior Provider Contracting SpecialistRole Overview:This advanced-level position is pivotal in establishing and nurturing strategic, creative, and data-driven partnerships with healthcare providers. The specialist will work autonomously to drive performance improvements, negotiate high-stake contracts, and maintain...

  • Senior Provider Contracting Specialist

    2 weeks ago

    New Port Richey, United States MASC Medical Full time

    Job DescriptionJob DescriptionPosition: Senior Provider Contracting SpecialistLocation: Trinity, FLRole Overview:This advanced-level position is pivotal in establishing and nurturing strategic, creative, and data-driven partnerships with healthcare providers. The specialist will work autonomously to drive performance improvements, negotiate high-stake...

  • contract specialist

    2 weeks ago

    New York, New York, United States Department Of The Air Force Full time

    Summary This National Guard position is for a Contract Specialist, Position Description Number T and is part of the 177TH MSQ GP.The primary purpose of this position is to ensure successful market research, acquisition planning, contract award, contract performance management, and interpretation of contract law in order to provide the best, most efficient...

  • contract specialist

    2 months ago

    New York, New York, United States Department Of The Air Force Full time

    Summary This National Guard position is for a Contract Specialist, Position Description Number T and is part of the 177TH MSQ GP.The primary purpose of this position is to ensure successful market research, acquisition planning, contract award, contract performance management, and interpretation of contract law in order to provide the best, most efficient...

  • Contract Specialist

    2 months ago

    New York, United States VNS Health Full time

    Reviews contracts and facilitates contracting with the VNS Health Plans provider network as it pertains to all provider types and for all VNS Health offered products. Negotiates and coordinates the implementation of provider agreements. Supports the Specialist, Contract, Contracts, Health, Network, Healthcare

  • Contracts Specialist, Clinical Research Contracts

    1 month ago

    New York, United States Memorial Sloan Kettering Full time

    The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done Clinical Research, Contracts, Contracts Specialist, Clinical, Research, Specialist, Healthcare, Business...

  • Senior Contracts Specialist

    3 weeks ago

    New York, United States MTA Full time

    Senior Contracts Specialist Job ID: 5876 Business Unit: MTA Construction & Development Location: New York, NY, United States Regular/Temporary: Regular Department: Construction Contracts Date Posted: Feb 9, 2024 Description This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after...

  • Senior Contracts Specialist

    3 weeks ago

    New York, United States MTA, Inc. Full time

    Senior Contracts Specialist Job ID: 5876 Business Unit: MTA Construction & Development Location: New York, NY, United States Regular/Temporary: Regular Department: Construction Contracts Date Posted: Feb 9, 2024 Description This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after...

  • Senior Contracts Specialist

    2 weeks ago

    New York, United States MTA Full time

    Senior Contracts Specialist Job ID: 5876 Business Unit: MTA Construction & Development Location: New York, NY, United States Regular/Temporary: Regular Department: Construction Contracts Date Posted: Feb 9, 2024 Description This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after...

  • Senior Contracts Specialist

    2 weeks ago

    New York, United States Metropolitan Transportation Authority Full time

    Position at MTA Construction & Development This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after their effective date of hire. JOB TITLE: Senior Contracts Specialist (Construction Contracts) AGENCY: Construction & Development DEPT/DIV: Contracts/Construction Contracts REPORTS...

  • Senior Contracts Specialist

    3 weeks ago

    New York, United States Metropolitan Transportation Authority Full time

    Position at MTA Construction & Development This position is eligible for telework which is currently one day per week. New hires are eligible to apply 30 days after their effective date of hire. JOB TITLE: Senior Contracts Specialist (Construction Contracts) AGENCY: Construction & Development DEPT/DIV: Contracts/Construction Contracts REPORTS...

  • Provider Network Development Specialist

    3 weeks ago

    New York, United States CINQCARE Full time

    CINQCARE NYS Provider Network Development Specialist Position Description Overview The Provider Network Development Specialist reports to the Director of Network Management with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody...

  • Provider Network Development Specialist

    3 weeks ago

    New York, United States CINQCARE Full time

    CINQCARE NYS Provider Network Development Specialist Position Description Overview The Provider Network Development Specialist reports to the Director of Network Management with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody...

  • Provider Network Development Specialist

    2 weeks ago

    New York, United States CINQCARE Full time

    CINQCARE NYS Provider Network Development Specialist Position Description Overview The Provider Network Development Specialist reports to the Director of Network Management with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody...

  • Provider Network Development Specialist

    6 days ago

    New York, United States CINQCARE Full time

    CINQCARE NYS Provider Network Development Specialist Position Description Overview The Provider Network Development Specialist reports to the Director of Network Management with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody...

  • Contract and Compliance Specialist

    2 days ago

    New York, United States Upwardly Global Full time

    **Title: Contract and Compliance Specialist** **Department: Finance** **Reports to: Director of Budget and Grants Compliance** **Location: New York, San Francisco, Chicago or DC** **FLSA Status: Exempt** **About the Organization** Over the years, Upwardly Global has supported thousands of immigrant and refugee professionals in transitioning from poverty or...

  • Director of Provider Contract Configuration

    16 hours ago

    New York, United States MetroPlusHealth Full time

    Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + Hospitals MetroPlus Health provides the highest...

  • Contract Specialist

    1 month ago

    New York, United States EmblemHealth Full time

    Summary of Position We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate...

  • Contract Specialist

    1 week ago

    New York, United States EmblemHealth Full time

    Summary of Position We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate...

  • Contract Specialist

    4 weeks ago

    New York, United States Career Movement Full time

    We are seeking a dynamic Contracts Specialist/Administrator to join our legal team and play a key role in managing a diverse range of contractual agreements. In this pivotal position, you will ensure adherence to legal and regulatory requirements, provide crucial support to the general counsel on special projects, and contribute to mitigating legal risks....