Molina Healthcare-posted 3 months ago
$57,394 - $117,808/Yr
Full-time
Louisville, KY
Insurance Carriers and Related Activities

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and JOCs on exception, including standardized fee for service and other core payment method contracts with predefined, common programs. Typically does not entail heavy negotiations. Minimal ongoing engagement after contract. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, and the 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.

  • Negotiate assigned contracts and letters of agreements with non-complex provider community.
  • Maintain tracking system and publish reports according to departmental procedures.
  • Contracting/re-contracting of standard deals, maintaining network adequacy, issue escalations and Joint Operating Committees on exception.
  • Initiate, negotiate, generate and track provider Letters of Agreement, contracts and amendments from initial draft to full execution.
  • Assess and negotiate contract language for ancillary providers.
  • Assist Manager and/or Director in the negotiation of medical group/IPA and hospital contracting.
  • Advise Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
  • Develop and maintain provider contracts in contract management software.
  • Target and recruit additional providers to reduce member access grievances.
  • Support network development throughout state including researching, recruiting and negotiating with providers.
  • Participate in the evaluation of provider network and implementation of strategic plans.
  • Communicate contract terms, payment structures, and reimbursement rates to providers.
  • Assist in analysis and coordination of amendments, reimbursement, and language changes.
  • Coordinate preparation and routing distribution of documents to complete the contracting process.
  • Facilitate and resolve claim and configuration issues with impacted departments.
  • Communicate proactively with other departments to ensure effective business results.
  • Participate with the management team and other committees addressing strategic goals.
  • Participate in other contracting related special projects as directed.
  • Some travel required.
  • Bachelor's Degree or equivalent work experience in health care field.
  • 5-7 years previous experience in contracting with large specialty or multispecialty provider groups.
  • 3+ years experience in provider contract negotiations in a managed healthcare setting.
  • Knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) contracts highly desirable.
  • Competitive benefits and compensation package.
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