[Hiring] Senior Representative, Health Plan Provider Relations @Molina Healthcare

Role Description

Provides senior level support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. 20% to 80% of travel is expected.

• Successfully engages the plan's highest priority, high-volume and strategic complex community providers to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
• Serves as the primary point of contact between Molina health plan and the complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
• Collaborates directly with the plan’s external providers to educate, advocate and engage as valuable partners.
• Resolves complex provider issues that may cross departmental lines and involve senior leadership.
• Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals.
• Provides on-the-spot training and education as needed, including counseling providers diplomatically.
• Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues.
• Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders.
• Independently delivers training and presentations to assigned providers and their staff.
• Performs an integral role in network management, by monitoring and enforcing company policies and procedures.
• Serves as a subject matter expert for the provider relations function.
• Provides training and support to new and existing provider relations team members.
• Role requires 80%+ same-day or overnight travel.

Qualifications

• At least 3 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.
• Understanding of the health care delivery system, including government-sponsored health plans.
• Understanding of various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business.
• Experience delivering training and facilitating educational presentations.
• Organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines effectively.
• Interpersonal skills, including 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.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Experience in provider services, operations, and/or contract negotiations in a Medicaid, Medicare, and/or Marketplace managed health care setting.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.