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Provider Relations Representative - Remote

Posted 1 week ago
Customer Service
Full Time
WI, USA

Overview

The Provider Relations Representative is responsible for network development, provider training, and ensuring compliance with Molina Healthcare policies while providing excellent customer service.

In Short

  • Primary contact for Molina Healthcare and contracted providers.
  • Educate and engage providers to ensure compliance with policies.
  • Conduct regular provider site visits.
  • Provide information on contracting processes and policies.
  • Assist in identifying trends and areas for improvement.
  • Coordinate problem-solving meetings with providers.
  • Deliver training and presentations to providers and their staff.
  • Monitor and enforce company policies and procedures.
  • Compile information from health services for contracted providers.
  • Lead Provider Quality Advisory Work Group Meetings.

Requirements

  • Associate's Degree or equivalent experience in managed healthcare.
  • 2-3 years of customer service or provider service experience.
  • Familiarity with managed healthcare provider compensation methodologies.
  • Bachelor’s Degree preferred.
  • 3+ years in managed healthcare administration preferred.

Benefits

  • Competitive benefits and compensation package.
  • Equal Opportunity Employer.

M.T.A

Molina Talent Acquisition

Molina Healthcare is a leading provider of managed healthcare services, dedicated to improving the health of its members through high-quality, cost-effective care. The company focuses on network strategy and development, ensuring compliance with federal, state, and local regulations while aligning with its core values and strategic goals. Molina Healthcare emphasizes the importance of building strong relationships with complex providers, including hospitals and physician groups, to enhance network adequacy and financial performance. With a commitment to value-based care, Molina Healthcare actively engages in contract negotiations and innovative reimbursement models to meet the diverse needs of its members.

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