Molina Healthcare
Representative, Provider Relations HP (Idaho HealthPlan)
Molina Healthcare, New York, New York, United States
Overview
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 overall 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 are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
Job Duties
This role serves as the primary point of contact between Molina Health Plan and the non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers, focusing on FQHC, large provider groups, and Behavioral Health. It is an external-facing, field-based position requiring a high degree of job knowledge, communication and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
Under minimal direction, works directly with the Plan’s external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.
Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. Proactively engages with the provider and staff to determine non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians, to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.
Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training to larger groups, such as leaders and management of provider offices, executive level decision makers, association meetings, and JOCs.
Performs an integral role in network management by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in Molina initiatives (e.g., administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and use of electronic solutions such as EDI, EFT, EMR, Provider Portal, Provider Website).
Trains other Provider Relations Representatives as appropriate.
Role requires 30+% same-day or overnight travel (extent of travel depends on the specific Health Plan and its service area).
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.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for-service, capitation and various forms of risk, ASO, etc.
Preferred Education : Bachelor’s Degree in a related field or an equivalent combination of education and experience
3+ years of experience in managed healthcare administration and/or Provider Services.
Experience with FQHC, large provider groups, and Behavioral Health.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $17.85 - $38.69 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Job Duties
This role serves as the primary point of contact between Molina Health Plan and the non-complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers, focusing on FQHC, large provider groups, and Behavioral Health. It is an external-facing, field-based position requiring a high degree of job knowledge, communication and organizational skills to successfully engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
Under minimal direction, works directly with the Plan’s external providers to educate, advocate and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.
Conducts regular provider site visits within assigned region/service area. Determines own daily or weekly schedule, as needed to meet or exceed the Plan's monthly site visit goals. Proactively engages with the provider and staff to determine non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, which may include counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed. Takes initiative in preventing and resolving issues between the provider and the Plan whenever possible.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians, to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.
Independently delivers training and presentations to assigned providers and their staff, answering questions that come up on behalf of the Health plan. May also deliver training to larger groups, such as leaders and management of provider offices, executive level decision makers, association meetings, and JOCs.
Performs an integral role in network management by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in Molina initiatives (e.g., administrative cost effectiveness, member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and use of electronic solutions such as EDI, EFT, EMR, Provider Portal, Provider Website).
Trains other Provider Relations Representatives as appropriate.
Role requires 30+% same-day or overnight travel (extent of travel depends on the specific Health Plan and its service area).
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.
Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-for-service, capitation and various forms of risk, ASO, etc.
Preferred Education : Bachelor’s Degree in a related field or an equivalent combination of education and experience
3+ years of experience in managed healthcare administration and/or Provider Services.
Experience with FQHC, large provider groups, and Behavioral Health.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $17.85 - $38.69 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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