Representative, Health Plan Provider Relations - Remote

Molina Healthcare•Portland, OR

2h•$22 - $44•Remote

About The Position

Provides administrative, operational, and provider relations support to coordinate and execute Provider Relations activities. The role organizes, tracks, schedules, reports on, documents, and maintains systems and workflows supporting provider engagement, issue resolution, network activities, and departmental priorities. The Representative coordinates meetings, maintains provider and operational trackers, pulls and analyzes routine reports, develops dashboards, monitors work queues and deliverables, and supports accurate documentation using systems including Salesforce and Microsoft 365 tools. The role also supports Provider Relations leadership and representatives by coordinating information and follow-up across internal teams, and may assist with routine provider communications, education, issue intake, research, and resolution. This position requires strong organization, attention to detail, follow-through, technical proficiency, and the ability to manage multiple priorities in a fast-paced, highly matrixed healthcare environment. It requires 10% travel within Washington and Oregon.

Requirements

At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or an 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 the 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.
Proficiency with the Microsoft Office suite and applicable software programs.

Nice To Haves

Familiarity with 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, and ASO.
Experience delivering training and facilitating educational presentations.

Responsibilities

Provide administrative and operational support for Provider Relations activities, initiatives, projects, and departmental priorities.
Organize and maintain Provider Relations workflows, trackers, calendars, reference materials, contact lists, assignments, and other operational resources.
Coordinate meetings, including scheduling, invitations, agendas, materials, attendance, notes, action items, and follow-up.
Track action items, deliverables, due dates, escalations, and outstanding requests to support timely completion and follow-through.
Maintain organized documentation and record information accurately in applicable systems and shared resources.
Support the development and maintenance of standardized Provider Relations processes, templates, job aids, workflows, and operating procedures.
Coordinate information between Provider Relations and internal departments, routing requests appropriately and tracking outstanding items through completion.
Pull routine operational reports and compile data to support Provider Relations leadership and team activities.
Create and maintain dashboards, trackers, spreadsheets, and other reporting tools to monitor workload, outreach, provider issues, assignments, performance measures, and departmental activities.
Review reports and tracking tools for completeness and accuracy and follow up on missing or incomplete information.
Organize data into summaries, reports, presentations, and dashboards for leadership and team review.
Support monthly, quarterly, and ad hoc reporting; maintain reporting calendars and coordinate timely completion of recurring reports and deliverables.
Identify trends, overdue activities, workflow gaps, and other items requiring follow-up and communicate them to appropriate team members or leadership.
Maintain Provider Relations information in Salesforce, SharePoint, Microsoft Teams, Excel, and other department tools.
Support consistent documentation of provider contacts, outreach, issues, escalations, meetings, and follow-up activities.
Perform data entry, validation, reconciliation, and routine quality checks to maintain accurate provider and departmental information.
Maintain electronic files, shared resources, templates, provider contact information, and departmental records.
Assist with standardized workflows to improve efficiency, consistency, visibility, and accountability.
Support routine and non-complex Provider Relations activities, including provider communications, outreach, education, and follow-up.
Respond to or appropriately route routine provider questions and requests; research routine provider issues and coordinate internally to support resolution.
Triage provider claim and operational issues to the appropriate department or Provider Relations representative.
Assist with provider roster, demographic, contact, and other data updates.
Support provider orientations, trainings, Joint Operating Committee meetings, outreach campaigns, and other provider engagement activities.
May maintain relationships with a limited portfolio of non-complex providers or provide coverage for Provider Relations representatives.
Support network development, provider research, recruitment, contracting activities, regulatory audits, and special projects as assigned.
Provide additional provider-facing support during increased volume, vacancies, special projects, or other business needs.