Provider Contracts Manager HP - Complex

Molina Health Plan Provider Network Contracting

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 Joint Operating Committees 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.

Job Duties

This role negotiates assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains 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.

• Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates / amendments, including but not limited to Fee for Service and Basic Alternative Payment Methods including Pay for Performance.
• Assesses and negotiates contract language for ancillary providers including, but not limited to Behavioral Health, Home Health, Hospice, Dialysis, Home and Community based providers. Ensure compliance with Corporate standards and regulatory requirements and review revised language with leadership based on feedback from assigned MHI attorney.
• Assists Manager and / or Director in the negotiation of medical group / IPA and hospital contracting.
• Advises Network Provider Contract Specialists on negotiation of individual provider and routine ancillary contracts.
• Identified as contract system lead by developing and maintaining provider contracts in contract management software.
• Targets and recruits additional providers to reduce member access grievances.
• Supports network development throughout state to including researching, recruiting and negotiating with providers.
• Participates in the evaluation of provider network and implementation of strategic plans to meet Molina's network adequacy standards.
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
• Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other information needed to complete the contract profile.
• Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes.
• Facilitates and resolves claim and configuration issues with impacted departments.
• Communicates proactively with other departments in order to ensure effective and efficient business results.
• Participates with the management team and other committees addressing the strategic goals of the department and organization.
• Participates in other contracting related special projects as directed.
• Some travel required.

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 :

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