Representative, Provider Relations HP - REMOTE

Job Summary Molina Health Plan Network Provider Relations 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 Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability, and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service. Responsibilities Serve as the primary point of contact between Molina Health plan and the non-complex Provider Community that services Molina members, including Fee-For-Service and Pay for Performance Providers. Engage high volume, high visibility providers, including senior leaders and physicians, to ensure provider satisfaction, educate on key Molina initiatives, and improve coordination and partnership. 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. Drive timely issue resolution, EMR connectivity, and Provider Portal adoption. Conduct regular provider site visits within assigned region/service area and meet or exceed monthly site visit goals. Proactively engage with providers and staff to identify non‑compliance with Molina policies, CMS guidelines, or regulatory requirements. Provide on‑the‑spot training and education, counseling providers diplomatically and maintaining positive relationships. Troubleshoot problems, determine escalation needs, and prevent and resolve issues between the provider and the Plan whenever possible. Initiate, coordinate, and participate in problem‑solving meetings with provider and Molina stakeholders regarding utilization management, pharmacy, quality of care, and coding issues. Deliver training and presentations to assigned providers and staff; may also lead larger groups such as leadership teams, multi‑specialty groups, health systems, executive decision makers, association meetings, and JOC’s. Monitor and enforce company policies and procedures, promote participation in Molina initiatives including administrative cost effectiveness, member satisfaction (CAHPS), regulatory programs, and electronic solutions (EDI, EFT, EMR, Provider Portal, Provider Website). Train other Provider Relations Representatives as appropriate. Travel 60% same‑day or overnight; travel frequency depends on the specific Health Plan and service area. Qualifications Required Education: Associate's Degree or equivalent in provider contract, network development and management, or project management experience in a managed healthcare setting. Required Experience/Education/Skills: 2-3 years of customer service, provider service, or claims experience in a managed care setting; working familiarity with various managed healthcare provider compensation methodologies across Medicaid and Medicare lines, including fee‑for‑service, capitation, risk, ASO, etc. Preferred Education: Bachelor's Degree in a related field or an equivalent combination of education and experience. Preferred Experience: 3 years in managed healthcare administration and/or Provider Services. Benefits Molina Healthcare offers a competitive benefits and compensation package. Pay Range: $19.84 – $38.69 per hour (actual compensation may vary based on geographic location, work experience, education, and skill level). Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. #J-18808-Ljbffr San Antonio Staffing