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Provider Contracting Specialist
2 months ago
**Job Summary**
Molina Healthcare's Provider Network Contracting team is responsible for developing and maintaining strategic relationships with healthcare providers to ensure high-quality, cost-effective care for our members. As a Provider Contracting Specialist, you will play a critical role in negotiating and managing contracts with complex providers, including hospitals, independent physician associations, and behavioral health organizations.
Key Responsibilities:
- Negotiate contracts with complex providers to ensure alignment with Molina's network strategy and compliance with regulatory requirements.
- Develop and maintain provider contracts in contract management software.
- Target and recruit additional providers to reduce member access grievances.
- Engage contracted providers in renegotiation of rates and/or language to positively impact the Medical Care Ratio (MCR) within each region.
- Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
- Maintains contractual relationships with significant/highly visible providers.
- Evaluates provider network and implements strategic plans to meet Molina's network adequacy standards.
- Assesses contract language for compliance with Corporate standards and regulatory requirements and reviews revised language with assigned MHI attorney.
- Participates in fee schedule determinations, including development of new reimbursement models, and seeks input from Corporate Network Management, legal, and VP-level engagement as required.
- Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital, and ancillary providers.
- Participates with the management team and other committees addressing the strategic goals of the department and organization.
Requirements:
- Bachelor's Degree in a healthcare-related field or an equivalent combination of education and experience.
- 5-7 years of contract-related experience in the healthcare field, including provider offices, managed care organizations, or other healthcare environments.
- 3+ years of experience in provider contract negotiations in a managed healthcare setting, ideally in negotiating different provider contract types.
- Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business.
