Representative, Health Plan Provider Relations - Duals/DSNP

Molina Healthcare•Long Beach, MA

About The Position

Provides support for health plan provider relations activities, including network development, network adequacy, and provider training and education. Serves as the primary point of contact between the health plan and contracted providers in the Molina network. Manages provider education, communication, satisfaction, issue intake, access and availability, and compliance with Molina policies and procedures. Engages high-volume, high-visibility providers to support satisfaction, education on Molina initiatives, and coordination between the health plan and providers. Serves non-complex providers, including fee-for-service and pay-for-performance providers. Works directly with external providers to educate and engage them, promote policy compliance, resolve issues, support electronic medical record connectivity, and encourage provider portal adoption. Conducts regular site visits in an assigned region or service area, scheduling visits to meet monthly goals. Provides on-site education, assesses non-clinical customer service and potential compliance issues, troubleshoots provider problems, and coordinates problem-solving meetings with providers and Molina stakeholders. Delivers training and presentations to provider offices and larger audiences. Monitors and enforces company policies and procedures while promoting provider participation in Molina initiatives and electronic solutions. May train and support provider relations team members. The role requires 60% or more same-day or overnight travel, depending on the health plan service area.

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 work with providers and medical office staff.
Ability to work in a cross-functional, highly matrixed organization.
Effective verbal and written communication skills.
Proficiency with Microsoft Office suite and applicable software programs.
Ability to meet the role's requirement for 60% or more same-day or overnight travel.

Nice To Haves

Familiarity with managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including fee-for-service, capitation, various forms of risk, and ASO.
Experience delivering training and facilitating educational presentations.

Responsibilities

Engage high-volume, high-visibility plan providers to promote provider satisfaction, educate them on Molina initiatives, and improve coordination and partnership with the health plan.
Serve as the primary contact for the non-complex provider community serving Molina members, including fee-for-service and pay-for-performance providers.
Educate and engage external providers, promote compliance with Molina policies and procedures, provide customer service, resolve issues, and support electronic medical record connectivity and provider portal adoption.
Conduct regular provider site visits in the assigned region or service area and meet or exceed monthly site visit goals.
Assess provider compliance with Molina policies and procedures and applicable CMS guidelines or regulations, and assess non-clinical customer service to Molina members.
Provide on-the-spot training and education, including diplomatically counseling providers while maintaining positive working relationships.
Troubleshoot provider problems and take initiative to prevent and resolve issues between providers and the health plan.
Initiate, coordinate, and participate in problem-solving meetings between providers and Molina stakeholders, including senior leadership and physicians.
Deliver training and presentations to assigned providers and their staff, and potentially to larger provider groups, health systems, executive decision-makers, association meetings, and joint operating committees.
Monitor and enforce company policies and procedures and educate providers to increase effectiveness and participation in Molina initiatives, including administrative cost-effectiveness, member satisfaction, regulatory-related initiatives, quality programs, EDI, EMR, provider portals, and provider websites.
Provide training and support to new and existing provider relations team members as appropriate.