*Remote and must live in Michigan*
Job Description
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.
Knowledge/Skills/Abilities
- In conjunction with the Director, Provider Contracts, develops health plan-specific provider contracting strategies, identifying specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members.
- Prepares the provider contracts in concert with established company guidelines with physicians, hospitals, MLTSS and other health care providers.
- Assists in achieving annual savings through recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
- Utilizes standardized contract templates and Pay for Performance strategies.
- Utilizes established Reimbursement Tolerance Parameters (across multiple specialties/ geographies). Oversees the development of new reimbursement models in concert with Director.
- Oversees the maintenance of all Provider and payer Contract Templates. Works with legal and Corporate Network Management on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
- Ensures compliance with applicable provider panel and network capacity, adequacy requirements and guidelines. Produces and monitors weekly/monthly reports to track and monitor compliance with network adequacy requirements.
- Develops and implements strategies to minimize the company's financial exposure. Monitors and adjusts strategy implementation as needed to achieve desire goals and reduce minimize the company's financial exposure..
Job Qualifications
Required Education
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
Required Experience
5-7 years
Preferred Education
Graduate degree
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.
Pay Range: $73,101 - $142,549 a year*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level
Pay Range: $65,791.66 - $142,548.59 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
