Senior Representative, Provider Services

Provider Network Management And Operations

Molina Health Plan Provider Network Management and Operations 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 Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

Knowledge/Skills/Abilities:

• Under general supervision, responsible for various provider services functions with an emphasis on working externally with the Plan’s highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.
• Requires an in-depth knowledge of provider services and contracting subject matter expertise.
• Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.
• Serves as a subject matter expert for other departments.
• Trains other Provider Services Representatives, as appropriate.

Job Qualifications:

• Required Education: Bachelor’s Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
• Required Experience:
• 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
• 3-5 years' experience in managed healthcare administration and/or Provider Services.
• 5 years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
• 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.
• Preferred Education: Bachelor’s or master’s degree.
• Preferred Experience:
• 5+ years' experience in managed healthcare administration and/or Provider Services.
• 5+ years' experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.

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