Provider Contracts Specialist

JOB SUMMARY :

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and 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:

Negotiates assigned contracts for physician groups and ancillary providers that result in high quality, cost effective and marketable providers. Maintains tracking system andpublish reports according to departmental procedures.

• Initiates, negotiates, generates contracts and amendments from initial draft to full executionutilizing approved standardized contract templates/amendments.

• AssistsManager and/or Director in the negotiation of medical group/IPA.

• Facilitates and resolves claim and configuration issues with impacted departments.

• Participates in other contracting related special projects as directed.

• Supportsnetwork development throughout state to includingresearching, recruiting and negotiating with providers.

• Participates in the evaluation of provider networkand implementation of strategic plans to meet

Molina’s networkadequacy standards.

• Clearly and professionally communicates contractterms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.

• Assistsin analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes,services provided and other information needed to completethe contract profile.

• 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 in order to ensure effective and efficient business results.

• Participates in other contracting related special projects as directed.