Summary:
Negotiates assigned contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. Essential Functions: Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments. 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 Molinas 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. Travels regularly throughout designated regions to meet targeted needs.
Knowledge/Skills/Abilities:
Knowledge in Excel, Word, Outlook, and PowerPoint programs Ability to interact well with all internal and external customers Ability to work and make decisions independently Excellent organizational and verbal and written communication skills Ability to abide by policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers