Senior Representative, Health Plan Provider Relations & Contracting (Michigan)

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

Job summary

Molina Healthcare in Michigan seeks a Senior Provider Relations Specialist to lead education, communication, and problem solving with contracted providers within the Molina network. You will manage provider satisfaction, training, and CMS/compliance initiatives while coordinating with leadership.

The role requires regional site visits, strong collaboration across departments, and the ability to resolve complex provider issues.

Qualifications

• 3+ years in customer service, provider services, or claims in managed care or medical office setting.
• Understanding of health care delivery system and government-sponsored plans.
• Knowledge of Medicaid/Medicare provider payment methods (FFS, capitation, risk).
• Experience delivering training and presentations.
• Strong organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines.
• Strong interpersonal and communication skills.
• Proficiency in Microsoft Office and related software.

Responsibilities

• Engage high-priority providers to ensure satisfaction and education on Molina initiatives.
• Serve as primary contact between Molina and complex provider community (FFS, P4P).
• Collaborate to educate, advocate, and ensure policy compliance while delivering excellent customer service; drive issue resolution and EMR/provider portal adoption.
• Resolve cross-department issues and coordinate with senior leadership.
• Conduct regular provider site visits and schedule planning to meet monthly goals.
• Provide on-the-spot training and diplomatically counsel providers to maintain relationships.
• Troubleshoot provider problems and preemptively resolve provider-plan issues.
• Lead problem-solving meetings with providers and Molina stakeholders, including executives.
• Deliver training/presentations to providers and their staff, from small groups to large multispecialty organizations.
• Promote participation in Molina initiatives like CAHPS and EDI/EMR/e-provider tooling.

Skills

Customer service

Provider services

Claims experience

Training delivery

Organizational skills

Multitasking

Interpersonal skills

Verbal and written communication

Microsoft Office

Job description

JOB DESCRIPTION

*Employee for this role must reside in Michigan

Job Summary

Provides senior level 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 the plan's highest priority, high-volume and strategic complex community 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 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.
• Resolves complex provider issues that may cross departmental lines and involve senior leadership.
• 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.).
• Serves as a subject matter expert for the provider relations function.
• Provides training and support to new and existing provider relations team members.
• Role requires team meeting travel once per quarter in the state of Michigan.

Required Qualifications

• At least 3 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.
• Understanding of the health care delivery system, including government-sponsored health plans.
• Understanding of 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.
• 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

• Experience in provider services, operations, and/or contract negotiations in a Medicaid, Medicare, and/or Marketplace managed health care setting - ideally with different provider types (i.e. physician, group, hospital).

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $49,930 - $97,363 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.