Provider Relations Representative
1 month ago
**Remote and must live 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.
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 mínimal 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.)
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 administrati
-
Provider Relations Representative
1 week ago
Long Beach, United States Molina Healthcare Full timeJob Description***Remote and must live in the San Diego area***Job DescriptionJob SummaryMolina 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...
-
Provider Relations Representative
2 weeks ago
Long Beach, United States Molina Healthcare Full timeJob Description***Remote and must live in downstate New York***Job DescriptionJob 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...
-
Senior Provider Relations Representative
4 weeks ago
Long Beach, United States Molina Healthcare Full timeJob Description***Remote and must live in New Mexico***Job DescriptionJob SummaryMolina 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,...
-
Senior Provider Relations Representative
2 weeks ago
Long Beach, United States Molina Healthcare Full timeJob Description***Remote and must live in New Mexico***Job DescriptionJob 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,...
-
Dir, Provider Relations
2 weeks ago
Long Beach, United States Molina Healthcare Full timeJob 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...
-
Customer Relations Representative
4 days ago
Long Beach, United States Brad Day - State Farm Agent Full timeJob DescriptionJob DescriptionROLE DESCRIPTION:As a Customer Relations Representative - State Farm Agent Team Member with BRAD DAY - State Farm Agent, you will generate the kind of exceptional client experiences that reinforce the growth of a successful insurance agency. Your attention to detail, customer service skills, and desire to help people make you an...
-
Long Beach, United States Molina Healthcare Full timeJob DescriptionJOB DESCRIPTIONJob Summary Molina Health Plan Dental Provider Network Management and Operations jobs are responsible for dental network development, dental network adequacy and dental provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant...
-
Admitting Representative, Er
5 days ago
Long Beach, United States Long Beach Memorial Medical Center Full time**Admitting Representative, ER** - (LON012308) **Description** - Title: Admitting Representative - Location: Long Beach, CA - Department: Admitting - Status: Full-time - Shift: Evening (8hr shifts) (12pm - 2:30am) - Pay Range: $21.05 - $24.40/hour - At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an...
-
Sales/Customer Relations Representative
2 weeks ago
Daytona Beach, United States Hydradry Full timeJoin Our Exciting Sales Team at Hydradry Inc.! Established in 1974, Hydradry Inc. is a leading Water/Fire/Mold Restoration Company, and we're on the lookout for dynamic individuals to join our team as Sales Representatives. Reporting to the Sales Manager, this role is your ticket to an engaging and rewarding career in the restoration industry. If you're...
-
Customer Support Representative
1 month ago
Long Beach, United States Recooty Full timeWe are seeking a customer support representative that excels in meeting customers' expectations, from answering questions on products and services to processing orders. You should assist in investigating issues that arise and resolving conflicts from customer complaints to ensure customer satisfaction. To be successful as a customer support representative,...
-
Member Relations Associate
4 days ago
Long Beach, United States Jewish Federation of Greater Long Beach and West O Full timeJob Description Job Description Description: The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities or requirements of this position. Employees are expected to perform other functions as assigned or requested to further support...
-
Family Nurse Practitioner
2 weeks ago
Long Beach, United States Provider Healthcare Full timeJob Type – Full Time Schedule – M-F 8-5 Pay – $142K - $152K, Depending on Experience Patients Per Day – 14 - 16 EMR System - NextGen Work Location – Home visits and Telehealth Job ID – 60503 Job Description A Long Beach based clinic is searching for a Nurse Practitioner who is passionate about improving individual and community health. An ideal...
-
Long Beach, United States Pacific Maritime Association Full timeABOUT PMA Put your experience and talents to work in a role with a unique company - the Pacific Maritime Association (PMA). PMA is a non-profit mutual benefit corporation that serves as a multi-employer collective bargaining agent for approximately 75 shipping lines, stevedore companies and marine terminal operators at California, Oregon and Washington...
-
Long Beach, United States Pacific Maritime Association Full timeABOUT PMA Put your experience and talents to work in a role with a unique company - the Pacific Maritime Association (PMA). PMA is a non-profit mutual benefit corporation that serves as a multi-employer collective bargaining agent for approximately 75 shipping lines, stevedore companies and marine terminal operators at California, Oregon and Washington...
-
Member Relations Associate
3 days ago
Long Beach, United States Jewish Federation of Greater Long Beach and West O Full timeJob DescriptionJob DescriptionDescription:The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities or requirements of this position. Employees are expected to perform other functions as assigned or requested to further support...
-
Customer Service Representative
2 weeks ago
Long Beach, United States iStaffing Inc Full timeiStaffing is currently looking for a Customer Service Representative in the city of Long Beach, Ca. **Responsibilities**: - Handle customer inquiries and complaints - Effectively communicating to Sales Team, Warehouse, office team and customers. - Provide information about the products and services - Troubleshoot and resolve product issues and concerns -...
-
Patient Relations Representative
3 days ago
Delray Beach, United States Gastro Health Full timeGastro Health is seeking a Full-Time Patient Relations Representative to join our team! Gastro Health is a great place to work and advance in your career. You'll find a collaborative team of coworkers and providers, as well as consistent hours. This role offers: A great work/life balance No weekends or evenings – Monday thru Friday Paid holidays and paid...
-
Customer Service Representative
2 weeks ago
Long Beach, United States Mario Bujas Insurance Agency Full timeJob DescriptionJob DescriptionWe are seeking a Customer Service Representative to join our team! You will be responsible for helping customers by providing product and service information and resolving technical issues.Responsibilities:Handle customer inquiries and complaintsProvide information about the products and servicesTroubleshoot and resolve product...
-
Manager, Provider Configuration
2 weeks ago
Long Beach, United States Molina Healthcare Full time**Remote and must live in the United States preferably in the Mountain time zone** Job Summary KNOWLEDGE/SKILLS/ABILITIES Establish and maintain internal standard operating procedures, and enterprise-wide policies and procedures pertaining to Provider functions ensuring alignment with business objectives. Collaborate with departments on issues related to...
-
Customer Service
2 weeks ago
Long Beach, United States Experiential Group Full timeJob DescriptionJob DescriptionWe are one of the most influential business development firms in Huntington Beach. Our partnership with telecommunication programs allows us to connect with local communities and provide free telecommunications services to improve their quality of life. To expand our efforts in helping our clients and communities achieve these...
