Provider Services Representative
Company: Molina Healthcare
Location: Ames
Posted on: January 25, 2023
Job Description:
JOB DESCRIPTION ****Remote and must live in Iowa*** Job Summary
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 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.
- Under minimal direction, works 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.
- Conducts regular provider site visits within assigned
region/service area. Determines own daily or weekly schedule, as
needed to meet or exceed the Plan's monthly site visit goals. A key
responsibility of the Representative during these visits is to
proactively engage with the provider and staff to determine, for
example, non-compliance with Molina policies/procedures or CMS
guidelines/regulations, or to assess the non-clinical quality of
customer service provided to Molina members.
- Provides on-the-spot training and education as needed, which
may include counseling providers diplomatically, while retaining a
positive working relationship.
- Independently troubleshoots problems as they arise, making an
assessment when escalation to a Senior Representative, Supervisor,
or another Molina department is needed. Takes initiative in
preventing and resolving issues between the provider and the Plan
whenever possible. The types of questions, issues or problems that
may emerge during visits are unpredictable and may range from
simple to very complex or sensitive matters.
- Initiates, coordinates, and participates in problem-solving
meetings between the provider and Molina stakeholders, including
senior leadership and physicians. Such meetings would occur to
discuss and resolve issues related to utilization management,
pharmacy, quality of care, and correct coding, for example.
- Independently delivers training and presentations to assigned
providers and their staff, answering questions that come up on
behalf of the Health plan. May also deliver training and
presentations to larger groups, such as leaders and management of
provider offices (including large multispecialty groups or health
systems, executive level decision makers, Association meetings, and
JOC's).
- Performs an integral role in network management, by monitoring
and enforcing company policies and procedures, while increasing
provider effectiveness by educating and promoting participation in
various Molina initiatives. Examples of such initiatives include
administrative cost effectiveness, member satisfaction - CAHPS,
regulatory-related, Molina Quality programs, and taking advantage
of electronic solutions (EDI, EFT, EMR, Provider Portal, Provider
Website, etc.).
- Trains other Provider Services Representatives as
appropriate.
- Role requires 80%+ same-day or overnight travel. (Extent of
overnight travel will depend on the specific Health Plan and its
service area.). 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-for 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. - To all current Molina employees: If you are
interested in applying for this position, please apply through the
intranet job listing. Molina Healthcare offers a competitive
benefits and compensation package. Molina Healthcare is an Equal
Opportunity Employer (EOE) M/F/D/V. Pay Range: $19.84 - $38.69 an
hour* *Actual compensation may vary from posting based on
geographic location, work experience, education and/or skill
level.
Keywords: Molina Healthcare, Ames , Provider Services Representative, Other , Ames, Iowa
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