Molina Healthcare
Representative, Provider Relations HP - REMOTE
Molina Healthcare, Granite Heights, Wisconsin, United States
Representative, Provider Relations HP - REMOTE
Job Summary
Molina Health Plan Network Provider Relations jobs are responsible for network development, network adequacy and provider training and education in alignment with Molina Healthcare's mission, core values, and strategic plan, and in compliance with all relevant federal, state and local regulations. Provider Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They manage network including provider education, communication, satisfaction, issue intake, access/availability, and ensure knowledge of and compliance with Molina healthcare policies while achieving the highest level of customer service.
Job Duties
Serve as the primary point of contact between Molina Health plan and the non-complex Provider Community servicing Molina members, including Fee-For-Service and Pay-for-Performance Providers.
Engage high volume, high visibility providers—including senior leaders and physicians—to ensure provider satisfaction, educate on key Molina initiatives, and improve coordination and partnership.
Educate, advocate and engage providers as valuable partners, ensuring knowledge of and compliance with Molina policies while delivering top customer service. Drive timely issue resolution, EMR connectivity, and Provider Portal adoption.
Conduct regular provider site visits within assigned region/service area. Determine daily or weekly schedule to meet or exceed monthly site visit goals. Engage providers to identify non-compliance with policies or CMS guidelines, and assess non‑clinical quality of customer service provided to Molina members.
Provide on‑the‑spot training and education as needed, counseling providers diplomatically while maintaining positive relationships.
Troubleshoot problems independently, assessing when escalation to a Senior Representative, Supervisor or other Molina department is needed.
Initiate, coordinate and participate in problem‑solving meetings between provider and Molina stakeholders—utilization management, pharmacy, quality of care, coding, etc.
Deliver training and presentations to assigned providers and staff, answer questions, and present to larger groups such as leaders, management, large multispecialty groups, health systems, executive decision makers, association meetings, and JOC’s.
Monitor and enforce company policies, promoting provider effectiveness by encouraging participation in Molina initiatives (administrative cost effectiveness, member satisfaction - CAHPS, regulatory programs, Molina Quality programs, EDI, EFT, EMR, Provider Portal, Provider Website).
Train other Provider Relations Representatives as appropriate.
Travel: 60%+ same‑day or overnight travel as required by the specific Health Plan and service area.
Job Qualifications
Required Education : Associate’s Degree or equivalent experience in provider contract, network development and management, or project management in a managed healthcare setting.
Required Experience / Knowledge, Skills & Abilities
2–3 years of customer service, provider service, or claims experience in a managed care setting.
Familiarity with managed healthcare provider compensation methodologies across Medicaid, Medicare, fee‑for‑service, capitation, risk, ASO, etc.
Preferred Education : Bachelor’s Degree in a related field or an equivalent combination of education and experience.
Preferred Experience
3+ years in managed healthcare administration and/or Provider Services.
Compensation Pay Range: $19.84 – $38.69 per hour. Actual compensation may vary based on location, experience, education and skill level.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Seniority Level: Mid‑Senior level Employment Type: Full‑time Job Function: Other Industry: Hospitals and Health Care
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Job Duties
Serve as the primary point of contact between Molina Health plan and the non-complex Provider Community servicing Molina members, including Fee-For-Service and Pay-for-Performance Providers.
Engage high volume, high visibility providers—including senior leaders and physicians—to ensure provider satisfaction, educate on key Molina initiatives, and improve coordination and partnership.
Educate, advocate and engage providers as valuable partners, ensuring knowledge of and compliance with Molina policies while delivering top customer service. Drive timely issue resolution, EMR connectivity, and Provider Portal adoption.
Conduct regular provider site visits within assigned region/service area. Determine daily or weekly schedule to meet or exceed monthly site visit goals. Engage providers to identify non-compliance with policies or CMS guidelines, and assess non‑clinical quality of customer service provided to Molina members.
Provide on‑the‑spot training and education as needed, counseling providers diplomatically while maintaining positive relationships.
Troubleshoot problems independently, assessing when escalation to a Senior Representative, Supervisor or other Molina department is needed.
Initiate, coordinate and participate in problem‑solving meetings between provider and Molina stakeholders—utilization management, pharmacy, quality of care, coding, etc.
Deliver training and presentations to assigned providers and staff, answer questions, and present to larger groups such as leaders, management, large multispecialty groups, health systems, executive decision makers, association meetings, and JOC’s.
Monitor and enforce company policies, promoting provider effectiveness by encouraging participation in Molina initiatives (administrative cost effectiveness, member satisfaction - CAHPS, regulatory programs, Molina Quality programs, EDI, EFT, EMR, Provider Portal, Provider Website).
Train other Provider Relations Representatives as appropriate.
Travel: 60%+ same‑day or overnight travel as required by the specific Health Plan and service area.
Job Qualifications
Required Education : Associate’s Degree or equivalent experience in provider contract, network development and management, or project management in a managed healthcare setting.
Required Experience / Knowledge, Skills & Abilities
2–3 years of customer service, provider service, or claims experience in a managed care setting.
Familiarity with managed healthcare provider compensation methodologies across Medicaid, Medicare, fee‑for‑service, capitation, risk, ASO, etc.
Preferred Education : Bachelor’s Degree in a related field or an equivalent combination of education and experience.
Preferred Experience
3+ years in managed healthcare administration and/or Provider Services.
Compensation Pay Range: $19.84 – $38.69 per hour. Actual compensation may vary based on location, experience, education and skill level.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Seniority Level: Mid‑Senior level Employment Type: Full‑time Job Function: Other Industry: Hospitals and Health Care
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