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Company: Molina Healthcare
Location: Augusta, ME
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech

Description



Job Description

Job Summary
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
• Provides support to the Provider Services Team in regards to receiving, researching and responding to provider inquiries.
• Receives, researches, and resolves provider inquiries such as claims, eligibility, and other inquiries. Act as a liaison between the providers, medical groups and health plan.
• Duties may include: (a) Price specific services based on the Plan's fee schedule; (b) Communicate and educate providers on important changes to regulations, procedures and access to information; (c) Assist Providers in dismissing or moving members incorrectly assigned to them; and/or (d) Educate providers so the appropriate dismissal letters are sent to Molina members.
• Supports other members of the Provider Services Team when they are in the field.
• Responsible for documenting requests as required in departmental procedures.
• Assists with training of new Provider Services staff members.
• Attends off-site meetings when necessary with medical groups and other providers as needed.
• Complies with required workplace safety standards.

Qualifications

Job Qualifications



Required Education
High School Diploma or equivalent GED
Required Experience
1 year customer service, provider service, or claims experience in a managed care or medical office setting.
Preferred Education
Associate's Degree
Vocational program in Managed Care or some other health care aspect providing a certificate at completion.

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.

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