Representative, Health Plan Provider Relations - Duals/DSNIP - Remote

Molina Healthcare, Inc.; Boston (MA); Remote; USD 31,000 - 61,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a Provider Relations role based in Boston, MA to strengthen relations with contracted providers, educate on Molina initiatives, and improve coordination between the health plan and providers.

You will travel to provider sites, conduct trainings, and ensure policy compliance while delivering excellent customer service. Responsibilities include site visits, issue resolution, EMR connectivity, and provider portal adoption.

Qualifications

• 2+ years in customer service/provider services/claims in managed care or medical office setting.
• Understanding of health care delivery systems and government-sponsored plans.
• Strong organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines.
• Effective verbal and written communication.
• Experience interfacing with providers and medical staff.
• Proficiency with Microsoft Office suite and related software.

Responsibilities

• Engage high-volume plan providers to ensure satisfaction and educate on Molina initiatives.
• Serve as primary contact between Molina and non-complex provider community.
• Educate and ensure compliance with Molina policies and procedures while enhancing customer service.
• Conduct provider site visits and coordinate schedules to meet goals.
• Provide on-the-spot training and education to providers and staff.
• Troubleshoot provider problems and coordinate issue resolution with Molina stakeholders.
• Lead problem-solving meetings across provider and Molina teams.
• Deliver training and presentations to providers and their staff, including large groups.
• Support network management by promoting Molina initiatives and EDI/EMR adoption.
• Provide training support to new and existing provider relations members.
• Travel 60%+ for same-day or overnight engagements.

Skills

Customer service

Provider services

Claims experience

Organizational skills

Multitasking

Interpersonal skills

Verbal and written communication

Microsoft Office

Tools

Microsoft Office

Job description

Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.

Essential Job Duties

• Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
• 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 (FFS) and pay-for-performance (P4P) providers.
• Collaborates 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; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
• Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
• Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
• Independently troubleshoots provider problems as they arise, and 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.
• Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding).
• 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 joint operating committees (JOCs).
• 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 - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
• May provide training and support to new and existing provider relations team members as appropriate.
• Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

Required Qualifications

• At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.
• General understanding of the health care delivery system, including government-sponsored health plans.
• Organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines effectively.
• Interpersonal skills, including ability to interface with providers and medical office staff.
• Ability to work in a cross-functional highly matrixed organization.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
• Experience delivering training and facilitating educational presentations.

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

Pay Range: $22.81 - $44.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.