Associate Representative, Health Plan Provider Relations

Job description

JOB DESCRIPTION Job Summary Provides entry level support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. Essential Job Duties: - Provides support for provider-related inquiries; successfully engages with providers and maintains provider satisfaction primarily for non-complex providers including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers. - Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries, and represents as a liaison between the providers, medical groups and the health plan. - Duties may include: price-specific services based on the plan’s fee schedule, communicating and educating providers on important changes to regulations, procedures and access to information, assisting providers in dismissing or mo...