Representative, Health Plan Provider Relations
On-siteMolina, Colorado, United States
Job Summary
Engage high-volume health plan providers as the primary point of contact, facilitating education on Molina initiatives and ensuring compliance with company policies and CMS guidelines. Conduct regular site visits to assess customer service quality, troubleshoot provider issues, and drive timely resolution for utilization management, pharmacy, and coding concerns. Deliver training and presentations to provider staff and executive decision-makers while promoting participation in quality programs and electronic solutions like EMR and EDI. Manage network adequacy, satisfaction metrics, and issue intake to improve coordination between the health plan and contracted providers. Requires 60%+ same-day or overnight travel to meet monthly site visit goals.
Required Qualifications
- 2 years of provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience
- General understanding of the health care delivery system, including government-sponsored health plans
- Organizational skills and attention to detail
- Ability to manage multiple tasks and deadlines effectively
- Interpersonal skills, including ability to interface with providers and medical office staff
- Ability to work in a cross-functional highly matrixed organization
- Effective verbal and written communication skills
- Microsoft Office suite and applicable software programs proficiency
- Experience delivering training and facilitating educational presentations
- 60%+ same-day or overnight travel
Desired Qualifications
- Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
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