A new position has opened up at Molina Healthcare for a Senior Representative, Provider Relations HP - Remote in NYC! Whether you're in our Remote hub or working remotely, you'll be a core part of the team. This position requires a strong and diverse skillset in relevant areas to drive success. We offer a competitive compensation package, with a salary of a competitive salary.
As a Senior Representative, Provider Relations HP, you will be 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. You will serve as the primary point of contact between Molina Healthcare and contracted provider networks, ensuring provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
This role is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high-priority providers, including senior leaders and physicians. You will work directly with the Plan's external providers to educate, advocate, and engage as valuable partners, ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service.
Your key responsibilities will include:
- Resolving complex provider issues that may cross departmental lines and involve Senior Leadership
- Serving as a subject matter expert for other departments
- Conducting regular provider site visits within assigned region/service area to proactively engage with providers and staff, determine non-compliance with Molina policies/procedures or CMS guidelines/regulations, and assess the non-clinical quality of customer service provided to Molina members
- Providing on-the-spot training and education as needed, including counseling providers diplomatically while retaining a positive working relationship
- Independently troubleshooting problems as they arise, making an assessment when escalation to a Senior Representative, Supervisor, or another Molina department is needed
- Initiating, coordinating, and participating in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians
- Delivering training and presentations to assigned providers and their staff, answering questions on behalf of the Health plan, and promoting participation in various Molina initiatives
- Performing an integral role in network management by monitoring and enforcing company policies and procedures, increasing provider effectiveness, and educating providers on various Molina initiatives
- Training other Provider Relations Representatives as appropriate
To be successful in this role, you will need:
- A Bachelor's Degree or equivalent provider contract, network development, and management, or project management experience in a managed healthcare setting
- 3-5 years of customer service, provider service, or claims experience in a managed care setting
- 3+ years of experience in managed healthcare administration and/or Provider Services
- Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines of business
- Excellent communication, interpersonal, and problem-solving skills
- Ability to work independently and as part of a team
- Strong analytical and organizational skills
- Ability to travel 80%+ of the time, including same-day and overnight travel
Preferred experience includes:
- 5+ years of experience in managed healthcare administration and/or Provider Services
- 3+ years of experience in provider contract negotiations in a managed healthcare setting
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. If you are a motivated and experienced professional looking to join a dynamic team, please apply now!
Your Future Starts Here
Don't miss out on this exciting role. We are looking forward to hearing from you. Apply now and take the first step towards a rewarding career with Molina Healthcare!
At Molina Healthcare, we are committed to providing high-quality healthcare services to our members. Our mission is to provide quality healthcare to those who need it most, and we are dedicated to making a positive impact in the lives of our members and the communities we serve. If you share our passion for delivering exceptional healthcare services and are looking for a challenging and rewarding career, we encourage you to apply for this exciting opportunity.
As a Senior Representative, Provider Relations HP, you will play a critical role in helping us achieve our mission. You will work closely with our provider networks to ensure that our members receive the best possible care, and you will be responsible for building and maintaining strong relationships with our providers. Your expertise and knowledge of provider relations and contracting will be essential in helping us to achieve our goals, and your excellent communication and interpersonal skills will enable you to build strong relationships with our providers and internal stakeholders.
In addition to your technical skills and experience, we are looking for someone who is passionate about delivering exceptional customer service and who is committed to making a positive impact in the lives of our members. If you are a motivated and experienced professional who is looking for a challenging and rewarding career, we encourage you to apply for this exciting opportunity.
At Molina Healthcare, we offer a competitive benefits and compensation package, including:
- Medical, dental, and vision insurance
- 401(k) retirement plan
- Paid time off and holidays
- Opportunities for professional development and growth
- A dynamic and supportive work environment
We are an Equal Opportunity Employer (EOE) M/F/D/V, and we welcome applications from diverse candidates. If you are a motivated and experienced professional who is looking for a challenging and rewarding career, we encourage you to apply for this exciting opportunity.
Apply now and take the first step towards a rewarding career with Molina Healthcare! Apply Now
Apply Now