Associate Representative, Health Plan Provider Relations - Remote must reside in UT

Job Summary

Must go to field as needed

Essential Job Duties

• Supports network development, network adequacy, and provider training and education
• Serves as primary point of contact between the business and contracted providers within the Molina network
• Engages with providers and maintains provider satisfaction primarily for non-complex providers including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers
• Represents as a liaison between the providers, medical groups and the health plan
• Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries
• Duties may include: price-specific services based on the plan’s fee schedule, communicating and educating providers on important changes to regulations, procedures and access to information, assisting providers in dismissing or moving members incorrectly assigned to them, and educating providers to ensure appropriate dismissal letters are sent to Molina members
• Supports other members of the provider relations team in the field
• Documents provider requests in alignment with established provider relations departmental procedures
• Facilitates provider relations mailbox response support
• Attends off-site meetings with medical groups and other providers as necessary
• Travels regularly throughout designated regions to meet targeted needs

Required Qualifications

• At least 1 year of customer service, 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

Preferred 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

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Pay Range

$18.04 - $35.17 / HOUR

Benefits & Compensation

Molina Healthcare offers a competitive benefits and compensation package.

Equal Opportunity Employer

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Company Information

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V