Serves as primary point of contact between the business and contracted providers within the Molina network.
Essential Job Duties • Successfully engages the plan's highest priority, high-volume and strategic complex provider community providers (including value-based payment (VBP) and other alternative payment method (APM) contracts to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
• Serves as the primary point of contact between Molina health plan and the for non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
• Collaborates 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; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
• Resolves complex provider issues that may cross departmental lines including contracting, finance, quality, operations, and may involve senior leadership.
• Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals.
Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medica.