Provider Quality Coordinator (Remote in WI)

Lensa; Madison (WI); Remote; Full time

Job summary

A leading healthcare organization is seeking a Provider Quality Coordinator to enhance provider relations and ensure compliance with Molina policies. The role involves extensive travel, training, and direct engagement with healthcare providers, focusing on customer satisfaction and issue resolution.

Qualifications

• 2-3 years in customer service, provider service, or claims within managed care.
• Familiarity with healthcare provider compensation models.

Responsibilities

• Educate and engage providers to ensure compliance and high customer service levels.
• Conduct regular provider site visits and provide training.
• Monitor policies and promote participation in Molina initiatives.

Skills

Customer Service

Provider Service

Claims

Education

Associate's Degree

Bachelor’s Degree

Job description

Provider Quality Coordinator (Remote in WI)

23 hours ago Be among the first 25 applicants

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Job Description

Job Summary

Molina Health Plan Network Provider Relations roles are responsible for network development, network adequacy, and provider training and education, aligning with Molina Healthcare's mission, values, and strategic plan, while complying with all relevant regulations. Provider Relations staff are the primary contact between Molina Healthcare and contracted providers, managing provider education, communication, satisfaction, issue resolution, access, and policy compliance, while delivering excellent customer service.

Job Duties

• Work directly with external providers to educate, advocate, and engage as partners, ensuring compliance with Molina policies and procedures, and achieving high customer service levels. Focus on issue resolution, EMR connectivity, and Provider Portal adoption.
• Conduct regular provider site visits within your region, scheduling as needed to meet visit goals. Engage with providers and staff to assess compliance and service quality.
• Provide on-the-spot training and education, including diplomatic counseling, to maintain positive relationships.
• Troubleshoot issues independently, escalating when necessary, and proactively prevent and resolve problems between providers and Molina.
• Participate in problem-solving meetings with stakeholders, including senior leadership and physicians, to address issues related to utilization, pharmacy, quality of care, and coding.
• Deliver training and presentations to providers and staff, including larger groups such as provider office management and associations.
• Monitor and enforce policies, promote participation in Molina initiatives, and increase provider effectiveness through education on cost efficiency, member satisfaction, regulatory compliance, and electronic solutions.
• Train other Provider Relations Representatives as appropriate.
• Travel extensively, with 60%+ same-day or overnight travel depending on the service area.

Job Qualifications

Required Education

Associate's Degree or equivalent experience in provider contracts, network development, or project management within managed healthcare.

Required Experience/Skills

• 2-3 years in customer service, provider service, or claims within managed care.
• Familiarity with healthcare provider compensation models, including Medicaid and Medicare, fee-for-service, capitation, risk models, and ASO.

Preferred Education

Bachelor’s Degree in a related field or equivalent experience.

Preferred Experience

3+ years in healthcare administration or Provider Services.

Current Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $19.84 - $38.69/hour. Compensation varies based on location, experience, education, and skills.

Additional Details

• Seniority Level: Mid-Senior level
• Employment Type: Full-time
• Job Function: Quality Assurance
• Industries: IT Services and IT Consulting