Representative, Health Plan Provider Relations - Duals/DSNIP - Remote

Molina Healthcare•Long Beach, CA

2d•Remote

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 business and contracted providers within the Molina network. Manages provider relationships through education, communication, satisfaction, issue intake, access and availability, and ensuring providers understand and comply with Molina policies and procedures. The position engages high-volume, high-visibility providers and supports coordination and partnership between the health plan and contracted providers. It conducts regular provider site visits in an assigned region or service area, delivers training and presentations, troubleshoots provider issues, and works with Molina stakeholders to resolve problems. 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 and 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 and applicable software programs.

Nice To Haves

Familiarity with managed health care provider compensation methodologies, particularly across Medicaid and Medicare, including fee-for-service, capitation, risk arrangements, and ASO.
Experience delivering training and facilitating educational presentations.

Responsibilities

Engage high-volume, high-visibility plan providers to support provider satisfaction, education on Molina initiatives, and coordination with the health plan.
Serve as the primary contact between Molina and non-complex providers serving Molina members, including fee-for-service and pay-for-performance providers.
Educate and engage external providers, promote compliance with Molina policies and procedures, resolve issues in a timely manner, and encourage electronic medical record connectivity and provider portal adoption.
Conduct regular provider site visits within the assigned region or service area and manage schedules to meet or exceed monthly site visit goals.
Assess provider compliance with Molina policies, procedures, and CMS guidelines or regulations, and assess non-clinical customer service quality.
Provide on-the-spot training and education, counseling providers diplomatically while maintaining positive working relationships.
Independently 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 involving providers and Molina stakeholders, including senior leadership and physicians.
Deliver training and presentations to providers and their staff, and potentially to larger groups such as provider-office leaders, health systems, executive decision makers, associations, and joint operating committees.
Monitor and enforce company policies and procedures while educating providers and promoting participation in Molina initiatives and electronic solutions.
May train and support new and existing provider relations team members.
Travel 60% or more, including same-day or overnight travel, depending on the health plan service area.