Provider Relations Representative

Molina Talent Acquisition

116d

About The Position

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.

Requirements

• Associate's Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
• 2 - 3 years customer service, provider service, or claims experience in a managed care setting.
• Working familiarity with various managed healthcare provider compensation methodologies.

Nice To Haves

• Bachelor’s Degree in a related field or an equivalent combination of education and experience.
• 3+ years experience in managed healthcare administration and/or Provider Services.

Responsibilities

• Serve as the primary point of contact between Molina Health plan and the non-complex Provider Community that services Molina members.
• Work directly with the Plan’s external providers to educate, advocate and engage as valuable partners.
• Conduct regular provider site visits within assigned region/service area.
• Provide on-the-spot training and education as needed.
• Independently troubleshoot problems as they arise.
• Initiate, coordinate and participate in problem-solving meetings between the provider and Molina stakeholders.
• Deliver training and presentations to assigned providers and their staff.
• Monitor and enforce company policies and procedures.
• Train other Provider Relations Representatives as appropriate.
• Role requires 60%+ same-day or overnight travel.

What This Job Offers

• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees