Senior Provider Relations Representative
Molina Healthcare New York, New York; Albany, New York; Rochester, New York; Yonkers, New York; Buffalo, New York; Syracuse, New York Job ID 2031873***Remote and must live in New York***
Job Description
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.
Job Duties
This role serves as the primary point of contact between Molina Health plan and the Plan's highest priority, high volume and strategic complex Provider Community that services Molina members, including but not limited to Fee-For-Service and Pay for Performance Providers. It is an external-facing, field-based position requiring an in-depth knowledge of provider relations and contracting subject matter expertise to successfully engage high priority providers, including senior leaders and physicians, to ensure provider satisfaction, education on key Molina initiatives, and improved coordination and partnership.
• Under general supervision, 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. Effectiveness in driving timely issue resolution, EMR connectivity, Provider Portal Adoption.
• Resolves complex provider issues that may cross departmental lines and involve Senior Leadership.
• Serves as a subject matter expert for other departments.
• 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. For example, such meetings would occur to discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding.
• 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 Relations 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/KNOWLEDGE, SKILLS & ABILITIES:
• 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
• 3+ years experience in managed healthcare administration and/or Provider Services.
• 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 EXPERIENCE:
• 5+ years experience in managed healthcare administration and/or Provider Services.
• 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e. physician, groups and hospitals).
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: $64,350 - $116,835 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 06/13/2025ABOUT OUR LOCATION
View Map- Care Manager: New Mexico Deming New Mexico, Las Cruces New Mexico, Roswell New Mexico, Albuquerque New Mexico, Santa Fe New Mexico, Rio Rancho New Mexico 05/28/2025
- Manager, Medical Economics (Pop Health/Clinical Analytics) - REMOTE Albany New York, Everett Washington, Florida, Kentucky, Nebraska, Iowa, Georgia, Michigan, Texas, Utah, Idaho, New York, Ohio, Washington, New Mexico, Wisconsin, Rio Rancho New Mexico, Salt Lake City Utah, Ann Arbor Michigan, Grand Rapids Michigan, Miami Florida, Syracuse New York, Yonkers New York, Covington Kentucky, Des Moines Iowa, Layton Utah, Warren Michigan, Spokane Washington, Buffalo New York, Rochester New York, Iowa City Iowa, Akron Ohio, Columbus Georgia, Green Bay Wisconsin, Jacksonville Florida, New York New York, Bowling Green Kentucky, Cleveland Ohio, Caldwell Idaho, Mesa Arizona, Austin Texas, Dallas Texas, Fort Worth Texas, Houston Texas, Sterling Heights Michigan, Detroit Michigan, Seattle Washington, Kearney Nebraska, Davenport Iowa, Cincinnati Ohio, Atlanta Georgia, Kenosha Wisconsin, Scottsdale Arizona, Albuquerque New Mexico, Tacoma Washington, Omaha Nebraska, Cedar Rapids Iowa, Macon Georgia, Madison Wisconsin, Meridian Idaho, Phoenix Arizona, Chandler Arizona, Tucson Arizona, San Antonio Texas, Las Cruces New Mexico, Orem Utah, Tampa Florida, Owensboro Kentucky, Lexington-Fayette Kentucky, Louisville Kentucky, Sioux City Iowa, Racine Wisconsin, Nampa Idaho, Idaho Falls Idaho, Santa Fe New Mexico, West Valley City Utah, Provo Utah, Orlando Florida, Dayton Ohio, Augusta Georgia, Milwaukee Wisconsin, Boise Idaho, Roswell New Mexico, Bellevue Washington, Vancouver Washington, St. Petersburg Florida, Bellevue Nebraska, Lincoln Nebraska, Grand Island Nebraska, Savannah Georgia 04/15/2025
- Manager, Medical Economics (Marketplace) - REMOTE Albany New York, Everett Washington, Idaho, Iowa, Kentucky, Florida, Michigan, New York, Georgia, Texas, Wisconsin, Ohio, Washington, Nebraska, New Mexico, Utah, Spokane Washington, Tampa Florida, Racine Wisconsin, Milwaukee Wisconsin, Idaho Falls Idaho, Roswell New Mexico, Grand Rapids Michigan, Buffalo New York, Bellevue Nebraska, Grand Island Nebraska, Phoenix Arizona, Santa Fe New Mexico, Albuquerque New Mexico, Orem Utah, Warren Michigan, Orlando Florida, Louisville Kentucky, Cincinnati Ohio, Columbus Georgia, Atlanta Georgia, Madison Wisconsin, Austin Texas, Las Cruces New Mexico, West Valley City Utah, Layton Utah, Miami Florida, New York New York, Omaha Nebraska, Boise Idaho, Meridian Idaho, Mesa Arizona, Rio Rancho New Mexico, Ann Arbor Michigan, Yonkers New York, Owensboro Kentucky, Lexington-Fayette Kentucky, Kearney Nebraska, Davenport Iowa, Des Moines Iowa, Cleveland Ohio, Columbus Ohio, Savannah Georgia, Chandler Arizona, Scottsdale Arizona, San Antonio Texas, Dallas Texas, Fort Worth Texas, Salt Lake City Utah, Bellevue Washington, Seattle Washington, Vancouver Washington, Rochester New York, Covington Kentucky, Sioux City Iowa, Dayton Ohio, Kenosha Wisconsin, Nampa Idaho, Tacoma Washington, St. Petersburg Florida, Syracuse New York, Bowling Green Kentucky, Lincoln Nebraska, Cedar Rapids Iowa, Akron Ohio, Macon Georgia, Houston Texas, Detroit Michigan, Jacksonville Florida, Iowa City Iowa, Augusta Georgia, Green Bay Wisconsin, Caldwell Idaho, Tucson Arizona, Provo Utah, Sterling Heights Michigan, Long Beach California 04/14/2025
- Sr QNXT Configuration Analyst - Benefits - Marketplace Albany New York, Everett Washington, Wisconsin, Nebraska, Kentucky, Iowa, Ohio, Washington, New Mexico, New York, Idaho, Utah, Texas, Georgia, Michigan, Florida, Augusta Georgia, Madison Wisconsin, Chandler Arizona, Dallas Texas, Rio Rancho New Mexico, Orem Utah, Seattle Washington, Spokane Washington, Miami Florida, Lexington-Fayette Kentucky, Columbus Ohio, Atlanta Georgia, Meridian Idaho, Austin Texas, Salt Lake City Utah, Provo Utah, Grand Rapids Michigan, Cincinnati Ohio, Sioux City Iowa, Scottsdale Arizona, San Antonio Texas, West Valley City Utah, Bellevue Washington, Tacoma Washington, Vancouver Washington, Syracuse New York, Covington Kentucky, Bowling Green Kentucky, Lincoln Nebraska, Dayton Ohio, Grand Island Nebraska, Racine Wisconsin, Albuquerque New Mexico, Ann Arbor Michigan, St. Petersburg Florida, Davenport Iowa, Akron Ohio, Macon Georgia, Milwaukee Wisconsin, Idaho Falls Idaho, Orlando Florida, Rochester New York, Owensboro Kentucky, Louisville Kentucky, Bellevue Nebraska, New York New York, Yonkers New York, Savannah Georgia, Columbus Georgia, Green Bay Wisconsin, Nampa Idaho, Fort Worth Texas, Las Cruces New Mexico, Roswell New Mexico, Layton Utah, Warren Michigan, Detroit Michigan, Jacksonville Florida, Tampa Florida, Buffalo New York, Cedar Rapids Iowa, Phoenix Arizona, Mesa Arizona, Houston Texas, Omaha Nebraska, Iowa City Iowa, Kearney Nebraska, Kenosha Wisconsin, Caldwell Idaho, Boise Idaho, Tucson Arizona, Santa Fe New Mexico, Sterling Heights Michigan, Des Moines Iowa, Cleveland Ohio 05/30/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs