Provider Relations Representative

Molina Healthcare; Long Beach (CA); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player is looking for a Provider Relations Representative to enhance provider partnerships and ensure compliance with healthcare policies. This role involves engaging with a diverse provider community, conducting site visits, and delivering training to optimize service delivery. With a focus on customer satisfaction, you will play a crucial role in network management while navigating the complexities of managed healthcare. If you're passionate about improving healthcare access and have a knack for relationship building, this opportunity is perfect for you. Join a team that values innovation and collaboration in delivering high-quality care.

Benefits

Competitive Benefits Package

Flexible Work Schedule

Professional Development Opportunities

Qualifications

• 2-3 years experience in customer service or provider service in managed care.
• Working familiarity with Medicaid and Medicare compensation methodologies.

Responsibilities

• Serve as the primary contact for providers, ensuring satisfaction and compliance.
• Conduct regular site visits and provide on-the-spot training as needed.

Skills

Customer Service

Provider Service

Claims Experience

Communication Skills

Organizational Skills

Problem-Solving

Medicare Knowledge

Education

Associate's Degree

Bachelor’s Degree

Tools

EMR Systems

Provider Portal

Job description

***Remote and must live in Contra Costa County for provider visits***

Job Description

Job Summary

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.

Job Duties

1. This role serves as the primary point of contact between Molina Health plan and the non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring a high degree of job knowledge, communication and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
2. Under minimal direction, works directly with the Plan’s external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.
3. Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with the provider and staff to determine non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
4. Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.
5. Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
6. Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.
7. Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training and presentations to larger groups, such as leaders and management of provider offices (including large multispecialty groups or health systems, executive level decision makers, Association meetings, and JOC's).
8. Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives. Examples of such initiatives include administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website, etc.).
9. Medicare subject matter expertise.
10. Trains other Provider Relations Representatives as appropriate.
11. Role requires 60%+ same-day or overnight travel. (Extent of same-day or overnight travel will depend on the specific Health Plan and its service area.)

Job Qualifications

REQUIRED EDUCATION:

Associate's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 2 - 3 years customer service, provider service, or claims experience in a managed care setting.

• Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for service, capitation and various forms of risk, ASO, etc.

PREFERRED EDUCATION:

Bachelor’s Degree in a related field or an equivalent combination of education and experience.

PREFERRED EXPERIENCE:

• 3+ years experience in managed healthcare administration and/or Provider Services.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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