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

Molina Healthcare•Midvale, ID

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 relationships through education, communication, satisfaction efforts, issue intake, access and availability, and support for compliance with Molina policies and procedures. The role engages high-volume, high-visibility providers to improve satisfaction, educate them about Molina initiatives, and strengthen coordination and partnership. It supports non-complex providers serving Molina members, including fee-for-service and pay-for-performance providers, and works with providers to resolve issues, encourage electronic medical record connectivity, and promote provider portal adoption. The Representative conducts regular site visits in an assigned region, plans visit schedules to meet monthly goals, and assesses provider practices and non-clinical customer service. The role provides on-the-spot training, troubleshoots provider concerns, coordinates problem-solving meetings with Molina stakeholders, and delivers presentations to providers and their staff, including larger groups and executive-level audiences. It also monitors and enforces company policies, promotes provider participation in Molina initiatives and electronic solutions, and may support the training of 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 and ability to interact 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, including fee-for-service, capitation, risk arrangements, 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 satisfaction, educate them about Molina initiatives, and improve coordination and partnership.
Serve as the primary point of contact between the Molina health plan and non-complex providers serving Molina members, including fee-for-service and pay-for-performance providers.
Educate and engage external providers, support compliance with Molina policies and procedures, provide customer service, resolve issues in a timely manner, and promote EMR connectivity and provider portal adoption.
Conduct regular provider site visits within the assigned region and schedule visits to meet or exceed monthly goals.
Engage providers and their staff to identify potential policy or regulatory non-compliance and assess non-clinical customer service to Molina members.
Provide on-the-spot provider training and education, including diplomatic counseling 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 provider problem-solving meetings with Molina stakeholders, including senior leaders and physicians.
Deliver training and presentations to assigned providers and staff, and potentially to larger provider groups, executives, association meetings, and joint operating committees.
Monitor and enforce company policies and procedures while educating providers and promoting participation in Molina initiatives and electronic solutions.
Provide training and support to new and existing provider relations team members as appropriate.
Travel 60% or more for same-day or overnight visits, depending on the health plan service area.