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Provider Contracts Specialist
3 months ago
**Remote and must live in New York**
**JOB SUMMARY**:
**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 mínimal 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.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
**Pay Range**: $17.85 - $38.69 / HOURLY
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
