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 accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple ... more details
***Remote and must live in California***
Job Description
Job Summary
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 accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, 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 supports negotiations with 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.
• Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members.
• Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures.
• Forwards requested information/documentation to prospective providers in a timely manner.
• Maintains database of all contracts and specific applications sent to prospective new providers.
• Completes and updates Provider Information Forms for each new contract.
• Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team.
• Sends out new provider welcome packets to providers who have contracted with the plan.
• Utilizes Plan’s system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management.
• Formats and distributes Provider network resources (e.g. electronic specialist directory).
Job Qualifications
REQUIRED EDUCATION:
High School Diploma or equivalent GED
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
1 year customer service, provider service, contracting or claims experience in the healthcare industry.
PREFERRED EDUCATION:
Associate’s Degree or Bachelor’s Degree in a related field or an equivalent combination of education and experience
PREFERRED EXPERIENCE:
Managed Care experience
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
