Molina Healthcare
Senior Provider Contracts Specialist
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Molina Healthcare
Remote hire must live in Michigan.
Job Summary Responsible for developing and maintaining network strategy, contracting, and data synchronization across claims systems, ensuring adequacy, financial performance, and compliance with all relevant regulations. The role involves executing standardized fee‑for‑service and alternative payment method contracts, managing contract renewals, and supporting network development across the state. Negotiation is limited to non‑complex providers with minimal ongoing engagement after contract sign‑off.
Job Duties
Initiate, negotiate, generate, and track provider Letters of Agreement, contracts and amendments using approved standardized templates.
Assist Manager or Director in negotiating medical group/IPA and hospital contracts.
Serve as contract system lead by developing and maintaining provider contracts within contract management software.
Support network development statewide, including research, recruitment, and negotiation with providers.
Participate in the evaluation and implementation of strategic plans to meet network adequacy standards.
Communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers.
Analyze and coordinate amendments, reimbursement, and language changes; request necessary billing and service information.
Coordinate preparation and distribution of documents to complete the contracting process in a timely manner.
Assist Manager or Director with Block Transfer Filings.
Communicate proactively with other departments to ensure efficient business results.
Train and monitor newly hired Contract Specialists.
Participate in other contracting‑related special projects as directed.
Travel regularly throughout designated regions to meet target needs.
Required Education Bachelor’s Degree or equivalent work experience in a health‑care field, including provider’s office, managed care, or other health‑care related work.
Required Experience
4‑6 years of contracting experience with large specialty or multispecialty provider groups.
1‑3 years of Managed Care experience.
Preferred Experience Knowledge of integrated delivery systems, hospital and group contracts (specialty and ancillary) is highly desirable.
Preferred License / Certification Certified Recovery Peer Specialist certification required in the state of Florida.
Benefits and Compensation Molina Healthcare offers a competitive benefits and compensation package.
Pay Range:
$26.41 – $51.49 / HOURLY (actual compensation may vary based on geographic location, experience, education, and skill level).
Equal Opportunity Employer Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Seniority level Mid‑Senior level
Employment type Full‑time
Job Function Legal
Industry Hospitals and Health Care
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at
Molina Healthcare
Remote hire must live in Michigan.
Job Summary Responsible for developing and maintaining network strategy, contracting, and data synchronization across claims systems, ensuring adequacy, financial performance, and compliance with all relevant regulations. The role involves executing standardized fee‑for‑service and alternative payment method contracts, managing contract renewals, and supporting network development across the state. Negotiation is limited to non‑complex providers with minimal ongoing engagement after contract sign‑off.
Job Duties
Initiate, negotiate, generate, and track provider Letters of Agreement, contracts and amendments using approved standardized templates.
Assist Manager or Director in negotiating medical group/IPA and hospital contracts.
Serve as contract system lead by developing and maintaining provider contracts within contract management software.
Support network development statewide, including research, recruitment, and negotiation with providers.
Participate in the evaluation and implementation of strategic plans to meet network adequacy standards.
Communicate contract terms, payment structures, and reimbursement rates to physicians, hospitals, and ancillary providers.
Analyze and coordinate amendments, reimbursement, and language changes; request necessary billing and service information.
Coordinate preparation and distribution of documents to complete the contracting process in a timely manner.
Assist Manager or Director with Block Transfer Filings.
Communicate proactively with other departments to ensure efficient business results.
Train and monitor newly hired Contract Specialists.
Participate in other contracting‑related special projects as directed.
Travel regularly throughout designated regions to meet target needs.
Required Education Bachelor’s Degree or equivalent work experience in a health‑care field, including provider’s office, managed care, or other health‑care related work.
Required Experience
4‑6 years of contracting experience with large specialty or multispecialty provider groups.
1‑3 years of Managed Care experience.
Preferred Experience Knowledge of integrated delivery systems, hospital and group contracts (specialty and ancillary) is highly desirable.
Preferred License / Certification Certified Recovery Peer Specialist certification required in the state of Florida.
Benefits and Compensation Molina Healthcare offers a competitive benefits and compensation package.
Pay Range:
$26.41 – $51.49 / HOURLY (actual compensation may vary based on geographic location, experience, education, and skill level).
Equal Opportunity Employer Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Seniority level Mid‑Senior level
Employment type Full‑time
Job Function Legal
Industry Hospitals and Health Care
#J-18808-Ljbffr