Managed Care Reporting & Contracts Specialist

Job Title: 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.