Senior Provider Relations Specialist

1 week ago


Lincoln, Nebraska, United States Molina Healthcare Full time
Job Overview

***Remote position; candidates must reside in Nebraska***

Position Summary

The Provider Relations roles at Molina Healthcare focus on developing and maintaining a robust network, ensuring network adequacy, and providing essential training and education to providers. These positions align with Molina's mission, core values, and strategic objectives while adhering to all applicable federal, state, and local regulations. The Provider Relations team serves as the primary liaison between Molina Healthcare and its contracted provider network, managing provider relations through education, communication, satisfaction, and issue resolution, all while delivering exceptional customer service.

Key Responsibilities

This position acts as the main contact for Molina Health Plan, engaging with high-priority, high-volume, and strategically important non-complex providers that serve Molina members. The role requires extensive knowledge of provider relations and contracting to effectively engage with key providers, including senior leadership and physicians, ensuring their satisfaction and understanding of Molina's initiatives.


• Collaborates directly with external providers to educate and advocate for them as essential partners, ensuring compliance with Molina's policies while delivering outstanding customer service. Effectively resolves issues, promotes EMR connectivity, and encourages Provider Portal usage.


• Addresses complex provider issues that may involve multiple departments and require senior leadership input.


• Acts as a subject matter expert for various departments.


• Conducts regular visits to provider sites within the designated region, managing their own schedule to meet the Plan's visit goals. Engages proactively with providers to identify compliance issues with Molina policies or CMS regulations and assess the quality of service provided to Molina members.


• Provides immediate training and education during site visits, maintaining a positive relationship while addressing any concerns.


• Independently resolves problems as they arise, determining when to escalate issues to senior representatives or other Molina departments. Takes proactive measures to prevent and resolve conflicts between providers and the Plan.


• Initiates and participates in problem-solving discussions between providers and Molina stakeholders, including senior leadership, to address issues related to utilization management, pharmacy, quality of care, and coding accuracy.


• Delivers training and presentations to providers and their staff, addressing questions on behalf of the Health Plan. May also present to larger groups, including executive decision-makers and association meetings.


• Plays a crucial role in network management by enforcing company policies and enhancing provider effectiveness through education and promotion of Molina initiatives, such as administrative efficiency, member satisfaction, and regulatory compliance.


• Trains other Provider Relations Representatives as needed.


• Position requires significant travel, including same-day and overnight trips, depending on the specific Health Plan and service area.

Qualifications

Education Required:

Bachelor's Degree or equivalent experience in provider contracting, network development, or project management within a managed healthcare environment.

Experience/Knowledge, Skills & Abilities Required:


• 3 - 5 years of experience in customer service, provider services, or claims within a managed care context.


• 3+ years of experience in managed healthcare administration and/or Provider Services.


• Familiarity with various managed healthcare provider compensation models, particularly in Medicaid and Medicare sectors, including fee-for-service and capitation.

Preferred Experience:


• 5+ years of experience in managed healthcare administration and/or Provider Services.


• 3+ years of experience in provider contract negotiations within a managed healthcare setting, particularly with different types of provider contracts.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $44, $97,362.61 / ANNUAL
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.



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