Senior Representative, Health Plan Provider Relations - Remote Must reside in NE
RemoteNebraska, United States
Job Summary
Engage the highest priority, high-volume, and strategic community providers to ensure satisfaction, facilitate education on key initiatives, and improve coordination between the health plan and contracted partners. Serve as the primary point of contact for the provider community, resolving complex cross-departmental issues and initiating problem-solving meetings with senior leadership. Conduct regular site visits within the assigned region to assess compliance with Molina and CMS policies, evaluate customer service quality, and deliver on-the-spot training and presentations to provider staff and executive decision-makers. Independently troubleshoot provider problems, drive EMR connectivity, and enforce company policies while promoting participation in quality and cost-effectiveness programs. Requires 80%+ same-day or overnight travel depending on the service area.
Required Qualifications
- At least 3 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience
- Understanding of the health care delivery system, including government-sponsored health plans
- Understanding of 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.
- Experience delivering training and facilitating educational presentations
- 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
- Role requires 80%+ same-day or overnight travel
Desired Qualifications
- Experience in provider services, operations, and/or contract negotiations in a Medicaid, Medicare, and/or Marketplace managed health care setting - ideally with different provider types (i.e. physician, group, hospital)
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.