Managed Care Reporting & Contracts Specialist

Managed Care Reporting & Contracts Specialist Department: Operations / Managed Care Programs 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. #J-18808-Ljbffr EPIC Healthcare