Managed Care Reporting & Contracts Specialist

Job Description

Job Description

Job Title: Managed Care Reporting & Contracts Specialist
Department: Operations / Managed Care Pr ograms
Reports To: Director of Finance

Overview: The Managed Care Reporting & Contracts Specialist is responsible for maintaining
Horizon’s relationships and compliance with Counties and Medi-Cal Managed Care Plans (MCPs)
across various CalAIM services, such as Recuperative Care and Enhanced Care Management
(ECM). This role oversees all reporting, credentialing and re-credentialing, audits, and contract
status tracking.

Key Responsibilities

1. MCP Reporting & Data Management

• Own the end-to-end production and submission of recurring County and MCP reports
• Attend information sessions, sometimes in-person, to stay on top of developments
• Maintain reporting calendars and internal trackers to ensure all reports are delivered on
  or before deadlines.
• Coordinate with internal departments and staff to obtain accurate census and
  clinical/operational data for each report.
• Review, validate, and clean data prior to submission to minimize rejections and
  correction cycles.
• Upload and submit reports through MCP portals and secure file transfer platforms
  according to each plan’s specifications
• Manage and respond to correction files and return transmissions from MCPs,
  coordinating revisions with internal staff and resubmitting within required timelines.

2. MCP Contracting, LOI & Credentialing

• Track the status of all County and MCP contracts and lines of business and by region
• Prepare, complete, and submit Letters of Interest (LOIs), provider information forms,
  and certification packets for new contracts and program expansions.
• Coordinate the full credentialing and certification process with MCPs, including:
  o Collecting required documents
  o Submitting policies and procedures as requested
  o Tracking timelines from LOI to certification to contract execution
• Manage annual re-credentialing for all contracted MCPs.
• Support tax ID and NPI updates with MCPs and vendors to avoid service or billing
  interruptions.

3. Capacity, Network Status & Surveys

• Complete and submit County and MCP capacity reports for various lines of business.
• Maintain up-to-date information for MCP provider directories, including locations,
  capacity, and service offerings.
• Monitor and respond to MCP surveys, network status checks, and directory attestations
  in coordination with leadership.

4. Audits, Compliance & Quality Assurance

• Coordinate and respond to County, MCP, and internal audits
• Support random MCP audits of patient information by gathering requested
  documentation
• Assist with background verification and compliance documentation requested for staff
• Ensure all submissions and communications adhere to MCP, Medi-Cal, and contractual
  requirements.

5. Managed Care Communications & Authorizations Support

• Monitor shared MCP email inboxes.
• Route authorizations, notices, and requests to the appropriate internal teams and track
  follow through as needed.
• Escalate urgent or complex items to leadership and follow up until resolved.

6. Grants, Special Projects & Hospital/Partner Reporting

• Support grant-related tasks such as researching opportunities, tracking deadlines, and
  assisting with application components as assigned.
• Assist leadership with surveys, special projects, and requests from health systems and
  hospitals.
• Maintain organized documentation of pending items and follow ups.

7. Team Leadership & Collaboration

• Provide day-to-day oversight, training, and quality review for reporting assistant(s)
  who populate templates and perform initial data entry.
• Standardize workflows and documentation so tasks can be handed off, trained, and
  scaled as the organization grows.
• Collaborate closely with operations, billing, admissions, program managers, and
  executive leadership to ensure alignment between MCP requirements and internal
  processes.
• Participate in recurring MCP and internal operations meetings as the primary point
  person for contracts and reporting.

Qualifications:

Required:

• Experience in managed care, health plan operations, revenue cycle, quality, or similar
  healthcare environment.
• Strong working knowledge of Medi-Cal managed care, preferably with exposure to
  ECM, Community Supports, or similar value-based programs.
• Demonstrated experience preparing complex recurring reports and submitting via
  portals or secure file transfer systems.
• High proficiency with Excel and other spreadsheet tools.
• Exceptional attention to detail and accuracy in data handling.
• Strong organizational skills with the ability to manage multiple deadlines and shifting
  priorities at once.
• Clear, professional, written, and verbal communication skills with the ability to
  interface directly with County and MCP representatives and internal leaders.

Preferred:

• Prior experience working with California MCPs such as LA Care, HealthNet, Molina,
  Blue Shield, CHG, or Kaiser.
• Familiarity with electronic health record systems such as PCC.
• Experience in Recuperative Care, ECM, homeless services, Housing Navigation, or
  post-acute/community-based care.
• Prior experience in contract management, credentialing, or network management.
• Experience supervising or mentoring staff in an operation or reporting function.