Senior Provider Relations Representative (Remote in MS)
About the position
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
Responsibilities
• Serve as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic complex Provider Community.
,
• Educate, advocate and engage with external providers to ensure knowledge of and compliance with Molina policies and procedures.
,
• Drive timely issue resolution, EMR connectivity, and Provider Portal Adoption.
,
• Resolve complex provider issues that may cross departmental lines and involve Senior Leadership.
,
• Conduct regular provider site visits within assigned region/service area.
,
• Proactively engage with providers and staff to assess non-compliance with Molina policies/procedures or CMS guidelines/regulations.
,
• Provide on-the-spot training and education to providers and their staff.
,
• Independently troubleshoot problems and assess when escalation is needed.
,
• Initiate, coordinate and participate in problem-solving meetings between the provider and Molina stakeholders.
,
• Deliver training and presentations to assigned providers and their staff.
,
• Monitor and enforce company policies and procedures while increasing provider effectiveness.
,
• Train other Provider Relations Representatives as appropriate.
,
• Travel 80%+ same-day or overnight.
Requirements
• Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
,
• 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
,
• 3+ years experience in managed healthcare administration and/or Provider Services.
,
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business.
Nice-to-haves
• 5+ years experience in managed healthcare administration and/or Provider Services.
,
• 3+ years experience in provider contract negotiations in a managed healthcare setting.
Benefits
• Competitive benefits and compensation package.
Apply Now
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
Responsibilities
• Serve as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic complex Provider Community.
,
• Educate, advocate and engage with external providers to ensure knowledge of and compliance with Molina policies and procedures.
,
• Drive timely issue resolution, EMR connectivity, and Provider Portal Adoption.
,
• Resolve complex provider issues that may cross departmental lines and involve Senior Leadership.
,
• Conduct regular provider site visits within assigned region/service area.
,
• Proactively engage with providers and staff to assess non-compliance with Molina policies/procedures or CMS guidelines/regulations.
,
• Provide on-the-spot training and education to providers and their staff.
,
• Independently troubleshoot problems and assess when escalation is needed.
,
• Initiate, coordinate and participate in problem-solving meetings between the provider and Molina stakeholders.
,
• Deliver training and presentations to assigned providers and their staff.
,
• Monitor and enforce company policies and procedures while increasing provider effectiveness.
,
• Train other Provider Relations Representatives as appropriate.
,
• Travel 80%+ same-day or overnight.
Requirements
• Bachelor's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
,
• 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
,
• 3+ years experience in managed healthcare administration and/or Provider Services.
,
• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business.
Nice-to-haves
• 5+ years experience in managed healthcare administration and/or Provider Services.
,
• 3+ years experience in provider contract negotiations in a managed healthcare setting.
Benefits
• Competitive benefits and compensation package.
Apply Now