Representative, Health Plan Provider Relations - Boise, ID / Spokane, WA

Molina Healthcare•Boise, ID

4d•$22 - $44

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 within the Molina network. The role manages provider relationships through education, communication, satisfaction, issue intake, access and availability, and promoting knowledge of and compliance with Molina policies and procedures. The position requires consistent travel to providers in the assigned service area, including travel to Spokane, Washington; Boise, Idaho; and Coeur d'Alene, Idaho. At least 60% of the role involves 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 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, capitation, various forms of risk, and ASO.
Experience delivering training and facilitating educational presentations.
Ability to travel consistently to Spokane, Washington; Boise, Idaho; and Coeur d'Alene, Idaho.

Responsibilities

Engage high-volume, high-visibility plan providers to support provider satisfaction, explain Molina initiatives, and strengthen coordination and partnership between the health plan and contracted providers.
Serve as the primary point of contact between Molina and the non-complex provider community serving Molina members, including fee-for-service and pay-for-performance providers.
Collaborate with external providers to educate, advocate, and engage them as partners; promote compliance with Molina policies and procedures and provide strong customer service.
Drive timely issue resolution, electronic medical record connectivity, and provider portal adoption.
Conduct regular provider site visits in the assigned region or service area, plan visit schedules, and meet or exceed monthly site-visit goals.
Engage providers and staff during visits to identify potential non-compliance with Molina policies, procedures, or CMS guidelines and assess non-clinical customer service quality.
Provide on-the-spot training and education, including diplomatically counseling providers while maintaining positive working relationships.
Independently troubleshoot provider problems, take initiative to prevent and resolve issues between providers and the health plan, and address matters that may range from simple to complex or sensitive.
Initiate, coordinate, and participate in provider problem-solving meetings with Molina stakeholders, including senior leaders and physicians, on matters such as utilization management, pharmacy, quality of care, and correct coding.
Deliver training and presentations to assigned providers and their staff, answer questions on behalf of the health plan, and present to larger groups, including provider-office leaders, health systems, executive decision makers, association meetings, and joint operating committees.
Monitor and enforce company policies and procedures while educating providers and promoting participation in Molina initiatives related to administrative cost-effectiveness, member satisfaction, regulatory requirements, quality programs, and electronic solutions.
Provide training and support to new and existing provider relations team members as appropriate.