Associate Representative, Health Plan Provider Relations

Molina Healthcare•Long Beach, CA

2d•Onsite

About The Position

Provides entry 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.

Requirements

At least 1 year 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.

Nice To Haves

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.

Responsibilities

Provides support for provider-related inquiries; successfully engages with providers and maintains provider satisfaction primarily for non-complex providers including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries, and represents as a liaison between the providers, medical groups and the health plan.
Duties may include: price-specific services based on the plan’s fee schedule, communicating and educating providers on important changes to regulations, procedures and access to information, assisting providers in dismissing or moving members incorrectly assigned to them, and educating providers to ensure appropriate dismissal letters are sent to Molina members.
Provides support to other members of the provider relations team in the field.
Documents provider requests in alignment with established provider relations departmental procedures.
Facilitates provider relations mailbox response support.
Attends off-site meetings with medical groups and other providers as necessary.
Travels regularly throughout designated regions to meet targeted needs.