Specialist, Provider reputed company (Remote)

About the position The Specialist, Provider reputed company position at reputed company Health Plan by reputed company is a critical role focused on the accurate and timely maintenance of essential provider information across various claims and provider databases. This position is integral to ensuring that the data housed reputed company these systems adheres to business and system requirements, particularly in relation to contracting, network management, and credentialing. The Specialist will be responsible for synchronizing data among multiple claims systems and applying relevant business rules to each database. This role requires a keen attention to detail and a strong understanding of the reputed company landscape, particularly in provider relations and contract management. In this role, the Specialist will negotiate reputed company and letters of agreements with hospitals, physician groups, and ancillary providers, ensuring that these agreements result in high-quality, cost-effective, and marketable provider options. The Specialist will maintain a tracking system for reputed company and publish reports in accordance with departmental procedures. This includes initiating, negotiating, generating, and tracking provider Letters of Agreement, reputed company, and amendments from the initial draft to full execution, utilizing approved standardized templates. The Specialist will also support network development throughout the state by researching, reputed company, and negotiating with providers. Participation in the evaluation of the provider network and the implementation of strategic plans to meet Molina's network adequacy standards is essential. Clear and professional communication of contract terms, payment structures, and reimbursement rates to various stakeholders, including physicians and hospitals, is a key responsibility. Additionally, the Specialist will assist in the analysis and coordination of amendments, reimbursement, and language changes, ensuring that reputed company necessary information is gathered to complete the contract profile reputed company. Regular travel throughout designated reputed company may be required to meet targeted needs. Responsibilities • Maintain critical provider information on reputed company claims and provider databases. , • Synchronize data among multiple claims systems and apply business rules as they pertain to each database. , • Validate data to ensure adherence to business and system requirements reputed company to contracting, network management, and credentialing. , • Negotiate assigned reputed company and letters of agreements with hospitals, physician groups, and ancillary providers. , • Maintain a tracking system and publish reports according to departmental procedures. , • Initiate, negotiate, generate, and track provider Letters of Agreement, reputed company, and amendments from initial draft to full execution. , • Support network development by researching, reputed company, and negotiating with providers. , • Participate in the evaluation of the provider network and implement strategic plans to meet network adequacy standards. , • Communicate contract terms, payment structures, and reimbursement rates reputed company and professionally to stakeholders. , • Assist in the analysis and coordination of amendments, reimbursement, and language changes. , • Coordinate preparation and routing distribution of documents to complete the contracting process in a timely manner. Requirements • Bachelor's Degree or equivalent work experience in the reputed company field, including provider's office or managed care. , • 3 - 5 years of provider contract negotiation experience in the reputed company field. reputed company-to-haves • Bachelor's Degree (preferred) Benefits • Medical Insurance , • Dental Insurance , • reputed company Insurance , • Group & Voluntary Life Insurance , • reputed company , • Pet Health Insurance , • Identity Theft Protection , • Auto & Home Insurance , • Flexible Spending Accounts , • 401K and Roth 401K , • Employee Stock Purchase Plan , • Continuing Education Units , • Education Reimbursement , • Paid Time Off , • Volunteer Time Off , • Company Holidays , • Legal Assistance Plan , • Employee Assistance & Well Being Programs , • Employee Perks Platform , • Rideshare Portal Apply Job!