Senior Specialist, Provider Contracts HP

Description

Job Summary

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to financial 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 accurate and timely maintenance of Value Based Contracts (VBCs) post execution, including but not limited to, data analysis and reporting that ensures VBCs fulfill APM provider payment and regulatory requirements related to state-mandated value-based programs. Supports Manager with contracting/re-contracting of VBCs, issue escalations and JOCs on exception. Synchronizes data among multiple systems when applicable and ensures adherence to business and system requirements of customers as it pertains to contracting and network management.

Job Duties

This role supports assigned contracts with VBC providers that result in high quality and cost-effective care. Maintains tracking system and publishes reports according to departmental procedures. Contracting/re-contracting of VBCs, issue escalations and Joint Operating Committees on exception.

• Assists Manager and/or Director in the negotiation of medical group/IPA and hospital VBC contracting.

• Serves as VBC regulatory data and reporting lead by developing and producing as required to engage with provider and facilitate VBC performance.

• Supports VBC network throughout the state to include onboarding VBC providers and supporting JOC’s.

• Clearly and professionally communicates VBC contract terms to VBC providers.

• 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 to ensure effective and efficient business results.

• Trains and monitors newly hired Contract Specialist(s).

• Participates in other VBC related special projects as directed.

• Limited team travel once to twice annually.

Job Qualifications

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:

• 4-6 years’ previous experience in contracting with large specialty or multispecialty provider groups.

• 1-3 Years Managed Care experience

PREFERRED EXPERIENCE:

Provider facing experience and knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) highly desirable. Experience generating financial reporting to meet regulatory requirements. Ohio based candidate desired; however, not required.