Senior Provider Relations & Contracting Expert (MI)

Molina Healthcare; Dearborn (MI); On-site; USD 50,000 - 97,000; Full time

Job summary

Molina Healthcare in Michigan is seeking an experienced Provider Relations Specialist to support network development, education, and member access. You will serve as the primary contact between Molina and contracted providers, ensuring adherence to policies and high-quality service across Medicare and Medicaid lines.

Responsibilities include engaging high-priority providers, conducting site visits, delivering trainings, resolving complex issues, and coordinating with senior leadership to

Qualifications

• At least 3 years of customer service, provider services, or claims experience in a managed care or medical office setting.
• Understanding of the health care delivery system, including government-sponsored health plans.
• Understanding of provider compensation methodologies (FFS, capitation, risk).
• Experience delivering training and facilitating educational presentations.

Responsibilities

• Engages high-priority, high-volume providers to improve satisfaction and education on Molina initiatives.
• Acts as primary contact between Molina and contracted providers within the network.
• Educates providers on Molina policies, CMS guidelines, and compliance requirements; drives issue resolution and portal adoption.
• Resolves complex provider issues that cross departments and involve senior leadership when needed.
• Conducts provider site visits; plans schedule to meet monthly goals and assesses non-clinical service quality.

Skills

Customer service

Provider services

Communication

Training delivery

Cross-functional collaboration

Tools

Microsoft Office

Job description

Molina Healthcare in Michigan is seeking an experienced Provider Relations Specialist to support network development, education, and member access. You will serve as the primary contact between Molina and contracted providers, ensuring adherence to policies and high-quality service across Medicare and Medicaid lines.

Responsibilities include engaging high-priority providers, conducting site visits, delivering trainings, resolving complex issues, and coordinating with senior leadership to