Senior Provider Relations Specialist

1 week ago


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

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

Position Summary

Molina Healthcare is seeking a dedicated professional for the role of Senior Provider Relations Representative. This position is integral to the development and management of our provider network, ensuring compliance with federal, state, and local regulations while aligning with Molina's mission and core values.

Key Responsibilities

The Senior Provider Relations Representative will serve as the main liaison between Molina Healthcare and our strategic provider community, which includes both Fee-For-Service and Pay for Performance Providers. This role demands a comprehensive understanding of provider relations and contracting to effectively engage with high-priority providers, including senior leaders and physicians.


• Operate under general supervision to educate and advocate for external providers, ensuring adherence to Molina policies while delivering exceptional customer service. This includes timely issue resolution and promoting the adoption of our Provider Portal.


• Address complex provider issues that may require collaboration across departments and involve senior leadership.


• Act as a subject matter expert, providing guidance to other departments as needed.


• Conduct regular site visits to providers within the assigned region, proactively engaging with them to identify compliance issues and assess the quality of service provided to Molina members.


• Deliver on-the-spot training and education, maintaining positive relationships while addressing provider concerns diplomatically.


• Independently troubleshoot issues, determining when to escalate matters to senior representatives or other Molina departments, and proactively resolving conflicts between providers and the Plan.


• Facilitate problem-solving meetings involving Molina stakeholders, including discussions on utilization management, pharmacy, quality of care, and coding accuracy.


• Provide training and presentations to assigned providers and their staff, addressing questions on behalf of Molina Healthcare, and occasionally to larger groups of provider office leaders.


• Play a crucial role in network management by enforcing company policies and enhancing provider effectiveness through education on various Molina initiatives, such as member satisfaction and quality programs.


• Mentor and train other Provider Relations Representatives as appropriate.


• The role requires over 40% travel, including same-day and overnight trips, depending on the specific Health Plan and service area.

Qualifications

Education:

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

Experience/Skills:


• 3 to 5 years of experience in customer service, provider service, or claims within a managed care setting.


• At least 3 years of experience in managed healthcare administration or Provider Services.


• Familiarity with various managed healthcare provider compensation methodologies, particularly in Medicaid and Medicare.

Preferred Experience:


• 5+ years in managed healthcare administration or Provider Services.


• 3+ years in provider contract negotiations within a managed healthcare context.

Molina Healthcare offers a competitive benefits and compensation package and 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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