Representative, Health Plan Provider Relations
Molina Healthcare, Milwaukee, Wisconsin, United States, 53244
Provides 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.
Essential Job Duties
Successfully engages high-volume, high-visibility plan 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 non-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, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
Conducts regular provider site visits within assigned region/service area, determining daily or weekly schedule to meet or exceed the plan’s monthly site visit goals. Proactively engages with the provider and staff to address non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations and assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, counseling providers diplomatically while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise and 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, addressing 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 and presentations to larger groups, including leaders and management of provider offices, large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
Performs an integral role in network management by monitoring and enforcing company policies and procedures, while increasing provider effectiveness through education and promotion of participation in various Molina initiatives, such as administrative cost-effectiveness, member satisfaction, regulatory compliance, Molina quality programs and utilization of electronic solutions (EDI, EMR, provider portal, provider website, etc.).
May provide training and support to new and existing provider relations team members as appropriate.
Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).
Required Qualifications
At least 2 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.
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 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
Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including fee-for-service (FFS), capitation and various forms of risk, ASO, etc.
Experience delivering training and facilitating educational presentations.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
#J-18808-Ljbffr
Essential Job Duties
Successfully engages high-volume, high-visibility plan 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 non-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, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
Conducts regular provider site visits within assigned region/service area, determining daily or weekly schedule to meet or exceed the plan’s monthly site visit goals. Proactively engages with the provider and staff to address non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations and assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, counseling providers diplomatically while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise and 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, addressing 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 and presentations to larger groups, including leaders and management of provider offices, large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
Performs an integral role in network management by monitoring and enforcing company policies and procedures, while increasing provider effectiveness through education and promotion of participation in various Molina initiatives, such as administrative cost-effectiveness, member satisfaction, regulatory compliance, Molina quality programs and utilization of electronic solutions (EDI, EMR, provider portal, provider website, etc.).
May provide training and support to new and existing provider relations team members as appropriate.
Role requires 60%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).
Required Qualifications
At least 2 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.
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 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
Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including fee-for-service (FFS), capitation and various forms of risk, ASO, etc.
Experience delivering training and facilitating educational presentations.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
#J-18808-Ljbffr