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Associate Provider Relations Representative
4 months ago
Job Description***Remote and must live in New York***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, 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 DutiesThis role serves as partner to the Provider Contracting and Provider Relations Team in regards to receiving, researching and responding to provider inquiries. It is internal and external facing position requiring job knowledge to resolve basic provider inquiries and communication skills to successfully engage with providers and maintain provider satisfaction primarily for non-complex Providers including but not limited to Fee-For-Service and Pay for Performance Providers.•Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan. •Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.•Supports other members of the Provider Services Team when they are in the field.•Responsible for documenting requests as required in departmental procedures. •Assists with training of new Provider Services staff members, including orientations, website navigation and education. •Attends off-site meetings when necessary with medical groups and other providers as needed. •Performs Mailbox Support .•Complies with required workplace safety standards.Job QualificationsREQUIRED EDUCATION:High School Diploma or equivalent GEDREQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:1 year customer service, provider service, or claims experience in a managed care or medical office setting.PREFERRED EDUCATION:Associate's DegreeVocational program in Managed Care or some other health care aspect providing a certificate at completion. PREFERRED EXPERIENCE:•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.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
