Representative, Health Plan Provider Relations - Remote

JOB DESCRIPTION Job Summary

Provides administrative, operational, and provider relations support to ensure the effective coordination and execution of Provider Relations activities. Responsible for organizing, tracking, scheduling, reporting, documenting, and maintaining systems and workflows that support provider engagement, issue resolution, network activities, and departmental priorities.

Coordinates meetings, maintains provider and operational trackers, pulls and analyzes routine reports, develops dashboards, monitors work queues and deliverables, and supports accurate documentation within applicable systems, including Salesforce and Microsoft 365 tools.

Provides support to Provider Relations leadership and representatives by coordinating information and follow-up across internal teams. May also support routine provider communications, education, issue intake, research, and resolution as needed.

The role requires strong organization, attention to detail, follow-through, technical proficiency, and the ability to manage multiple priorities in a fast-paced, highly matrixed healthcare environment.

Essential Job Duties

Provider Relations Operations & Administrative Coordination

• Provides administrative and operational support for Provider Relations activities, initiatives, projects, and departmental priorities.
• Organizes and maintains Provider Relations workflows, trackers, calendars, reference materials, contact lists, assignments, and other operational resources.
• Coordinates meetings, including scheduling, invitations, agendas, materials, attendance, meeting notes, action items, and follow-up.
• Tracks action items, deliverables, due dates, escalations, and outstanding requests to support timely completion and appropriate follow-through.
• Maintains organized documentation and ensures information is accurately recorded in applicable systems and shared resources.
• Supports development and maintenance of standardized Provider Relations processes, templates, job aids, workflows, and operating procedures.
• Coordinates information between Provider Relations and internal departments to ensure requests are routed appropriately and outstanding items are tracked through completion.
• 10% travel required within WA/OR

Reporting, Tracking & Dashboards

• Pulls routine operational reports and compiles data to support Provider Relations leadership and team activities.
• Creates and maintains dashboards, trackers, spreadsheets, and other reporting tools to monitor workload, outreach, provider issues, assignments, performance measures, and departmental activities.
• Reviews reports and tracking tools for completeness and accuracy and follows up on missing or incomplete information.
• Organizes data into clear summaries, reports, presentations, and dashboards for leadership and team review.
• Supports recurring monthly, quarterly, and ad hoc reporting requirements.
• Identifies trends, overdue activities, workflow gaps, and other items requiring follow-up and communicates them to appropriate team members or leadership.
• Maintains reporting calendars and coordinates timely completion of recurring reports and deliverables.

Systems & Documentation

• Maintains Provider Relations information within applicable systems, including Salesforce, SharePoint, Microsoft Teams, Excel, and other department tools.
• Supports consistent documentation of provider contacts, outreach, issues, escalations, meetings, and follow-up activities.
• Performs data entry, data validation, reconciliation, and routine quality checks to maintain accurate provider and departmental information.
• Maintains electronic files, shared resources, templates, provider contact information, and departmental records.
• Assists with development and maintenance of standardized workflows to improve efficiency, consistency, visibility, and accountability.

Provider Relations Support

• Serves as a support resource for routine and non-complex Provider Relations activities.
• Assists with provider communications, outreach, education, and follow-up as assigned.
• Responds to or appropriately routes routine provider questions and requests.
• Researches routine provider issues and coordinates with internal departments to support resolution.
• Accurately triages provider claim and operational issues to the appropriate department or Provider Relations representative.
• Assists with provider roster, demographic, contact, and other data updates.
• Supports provider orientations, trainings, Joint Operating Committee meetings, outreach campaigns, and other provider engagement activities.
• May maintain relationships with a limited portfolio of non-complex providers or provide coverage for Provider Relations representatives as needed.
• Supports network development, provider research, recruitment, contracting activities, regulatory audits, and special projects as assigned.
• Provides additional provider-facing support during periods of increased volume, vacancies, special projects, or other business needs.

Required Qualifications

• At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.  
• General understanding of the health care delivery system, including government-sponsored health plans.
• Organizational skills and attention to detail.
• Ability to manage multiple tasks and deadlines effectively.
• Interpersonal skills, including ability to interface with providers and medical office staff.
• Ability to work in a cross-functional highly matrixed organization.
• Effective verbal and written communication skills.  
• Microsoft Office suite and applicable software programs proficiency.
 

Preferred Qualifications

• Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including:  fee-for service (FFS), capitation and various forms of risk, ASO, etc.
• Experience delivering training and facilitating educational presentations.
 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V