Molina Healthcare Sr Rep, Provider Services in United States
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 (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):
• Under general supervision, responsible for various provider services functions with an emphasis on working externally with the Plan’s highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.
• Requires an in-depth knowledge of provider services and contracting subject matter expertise.
• Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.
• Serves as a subject matter expert for other departments.
• Trains other Provider Services Representatives, as appropriate.
Bachelor’s Degree or equivalent provider contract, network development and management, or project management experience in a managed healthcare setting.
• 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
• 3-5 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.
• 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.
Bachelor's or Master's Degree.
• 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.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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