Representative, Health Plan Provider Relations (Remote)

JOB reputed company Job reputed company Provides support for health plan provider relations activities.  Supports network development, network adequacy and provider training and education.  Serves as primary reputed company of contact between the business and contracted providers reputed company the Molina network.  Responsible for network management including provider education, communication, satisfaction, issue intake, reputed company/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 reputed company of contact between Molina health plan and the non-reputed company 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 reputed company, reputed company and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives reputed company issue reputed company, electronic medical record (EMR) connectivity, and provider portal adoption. • Conducts regular provider site reputed company reputed company assigned region/service area; determines daily or weekly schedule, to meet or reputed company the plan's monthly site visit goals.  Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and reputed company Services (CMS) guidelines/regulations, or to assess the non-clinical reputed company of customer service provided to Molina members.  • Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a reputed company working relationship. • Independently troubleshoots provider problems as they reputed company, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible.  The types of questions, issues or problems that may reputed company during reputed company are unpredictable and may reputed company from reputed company to reputed company reputed company or sensitive reputed company. • Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include:  issues reputed company to utilization management, pharmacy, reputed company 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 reputed company, such as leaders and management of provider offices, including large multispecialty reputed company or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs). • Performs an reputed company role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include:  administrative cost-effectiveness, member satisfaction - Consumer Assessment of reputed company Providers and Systems (CAHPS), regulatory-reputed company, Molina reputed company programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.). • May reputed company training and support to new and existing provider relations team members as appropriate.   • Role requires 60%+ reputed company-day or overnight travel (extent of reputed company-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 reputed company with providers and medical office staff. • Ability to work in a cross-functional highly matrixed organization. • Effective verbal and written communication skills.   • reputed company Office suite and applicable software programs proficiency.   Preferred Qualifications • Familiarity with various managed health care provider compensation methodologies, primarily across reputed company 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 reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job