Provider Relations Representative
Company: Molina Healthcare
Location: White Plains
Posted on: May 7, 2024
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Job Description:
***Remote and must live in downstate New York***
Job Description
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.
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Job Duties
This role serves as the primary point of contact between Molina
Health plan and the for non-complex Provider Community that
services Molina members, including but not limited to
Fee-For-Service and Pay for Performance Providers. - 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. - A
key responsibility of the Representative during these visits is to
proactively engage with the provider and staff to determine; for
example, 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. - The types of questions, issues or problems
that may emerge during visits are unpredictable and may range from
simple to very complex or sensitive matters.
--- Initiates, coordinates and participates in problem-solving
meetings between the provider and Molina stakeholders, including
senior leadership and physicians. - For example, such meetings
would occur 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 and
presentations to larger groups, such as leaders and management of
provider offices (including large multispecialty groups or health
systems, executive level decision makers, Association meetings, and
JOC's).
--- 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
various Molina initiatives. -Examples of such initiatives include:
-administrative cost effectiveness, member satisfaction - CAHPS,
regulatory-related, Molina Quality programs, and taking advantage
of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider
Website, etc.).
--- Trains other Provider Relations Representatives as
appropriate.
--- Role requires 60%+ same-day or overnight travel. - (Extent of
same-day or overnight travel will depend on the specific Health
Plan and its service area.)
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Job Qualifications
REQUIRED EDUCATION:
Associate's Degree or equivalent provider contract, network
development and management, or project management experience in a
managed healthcare setting.
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
--- 2 - 3 years 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
PREFERRED EXPERIENCE:
--- - 3+ years experience in managed healthcare administration
and/or Provider Services. -
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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.
#PJCorp Pay Range: $17.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Springfield , Provider Relations Representative, Other , White Plains, Massachusetts
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