Provider Services Representative

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.

This role serves as the primary point of contact between Molina Health Plan and the Provider community that serves Molina members. It's an external-facing, field-based position requiring a high degree of job knowledge, communication, and organizational skills to successfully engage high volume, high visibility providers (including senior leaders and physicians) to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.

The key responsibilities include:

• Working directly with the Plan's external providers to educate, advocate, and engage as valuable partners.
• Conducting regular provider site visits within assigned region/service area.
• Providing on-the-spot training and education as needed.
• Independently troubleshooting problems as they arise.
• Initiating, coordinating, and participating in problem-solving meetings between the provider and Molina stakeholders.
• Independently delivering training and presentations to assigned providers and their staff.
• Performing an integral role in network management, by monitoring and enforcing company policies and procedures.
• Training other Provider Services Representatives as appropriate.
• Role requires 80%+ same-day or overnight travel.

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:

2 - 3 years customer service, provider service, or claims experience in a managed care setting.

Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to, fee-service, capitation, and various forms of risk, ASO, etc.

Preferred Education:

Bachelor'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. Pay Range: $21.16 - $46.42 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.