Top 920 Senior representative Jobs in Corona Ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)
Molina Healthcare, Inc. —Corona, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
12d
Customer Service Representative
Matthews International Corporation —Fontana, CA
- Overtime
- Microsoft Outlook
- Basic math
- Mid-level
Director of Sales Enablement
Confidential —Irvine, CA
- $180,000 - $240,000 a year
- Full-time
- Office
- 3 years
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Leasing Consultant LIHTC/Senior Housing - Heritage Villas
Quality Management Group Inc —Mission Viejo, CA
- From $22.66 an hour
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
Senior Account Executive (Bilingual in English & Mandarin)
Postron —City of Industry, CA
- Up to $8,000 a month
- Full-time
- Sales
- 5 years
- English
- Health insurance
- Dental insurance
Quick Apply
Sr. Community Manager - LIHTC & Conventional- Scattered Sites
Quality Management Group Inc —Ontario, CA
- $33 - $35 an hour
- Weekends as needed
- Microsoft Outlook
- Inventory management
- Word processing
Quick Apply
Financial Professional with Management Opportunity
New York Life Insurance Company —Riverside, CA
- $51,000.00 - $156,603.44 a year
- Full-time
- Mid-level
- Business development
- US work authorization
- AD&D insurance
- Disability insurance
Quick Apply
6d
Senior Project Manager – Restoration & Reconstruction (Residential & Commercial)
JCS Restoration —Lake Elsinore, CA
- $80,000 - $90,000 a year
- Full-time
- Construction site
- 5 years
- Residential
- Health insurance
- Dental insurance
Quick Apply
Director of Sales & Marketing Hotel
Sonesta Hotels Anaheim and Sonesta ES Suites Anaheim Complex —Anaheim, CA
- $125,000 - $145,000 a year
- Online Application
- Background check
- Basic math
- Hotel
- Paid parental leave
- Health savings account
Quick Apply
Autism Behavior Interventionist
The Carolyn E. Wylie Center —Riverside, CA
- $20 - $22 an hour
- Part-time
- Bilingual
- Background check
- Basic math
- Professional development assistance
- Referral program
Quick Apply
Frontier Team Member
PDE Enterprises —West Covina, CA
- $48,000 - $58,000 a year
- Full-time
- Background check
- Marketing
- High school diploma or GED
Quick Apply
Senior Quality Engineer
Lubrizol —Corona, CA
- $135,000 - $145,000 a year
- Full-time
- 5 years
- Engineering
- Master's degree
- Health savings account
- Paid holidays
6d
Debt Settlement & Tax Resolution Sales Consultant (Inside Sales Closer)
Tax Resolution Plus —Irvine, CA
- $37,000 - $90,000 a year
- Full-time
- Office
- 1 year
- Entry level
- Paid training
- On-the-job training
Quick Apply
GRC Senior Security Analyst
Kura Sushi Corporate Support Center —Irvine, CA
- $90,000 - $100,000 a year
- Full-time
- Hybrid work
- Azure
- Computer Science
- 5 years
- Health insurance
- Dental insurance
Quick Apply
6d
New Account Representative
First Commercial Bank(USA) —City of Industry, CA
- From $35,397 a year
- Full-time
- Background check
- English
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Broker Account Manager
Astiva Health —Orange, CA
- $70,000 - $85,000 a year
- Bilingual
- Clean driving record
- Public speaking
Quick Apply
12d
Site Facilitator
YWCA of San Gabriel Valley —Covina, CA
- From $17.87 an hour
- Part-time
- Background check
- Clean driving record
- ServSafe
- Employee assistance program
Quick Apply
Project Manager II
Corovan —Fullerton, CA
- $26.50 - $29.53 an hour
- Overtime
- Microsoft Excel
- Bachelor of Science
- English
Quick Apply
Community Relations Representative
Efficient California —Grand Terrace, CA
- $950 - $1,550 a week
- Full-time
- Mid-level
- Presentation skills
- In-person
- 401(k)
Quick Apply
7d
Client Escalation Specialist
TaxRise —Irvine, CA
- $26 - $28 an hour
- Overtime
- Background check
- Office
- 3 years
- Paid training
- Health insurance
Quick Apply
9d

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Senior Representative, Health Plan Provider Relations (Must Reside in CA)

Molina Healthcare, Inc. -
Corona, CA

Apply Now

Job Details

Full-time
$73,008 - $111,967 a year
12 days ago

Benefits

Health insurance

Qualifications

Customer training
Medicare
Managed care organization experience
Medical office experience
Educational talks
Schedule management
Corporate training teaching experience
Health insurance knowledge
Medicare regulations
Desktop applications
Medicaid regulations
Medicaid
Productivity software
Cross-functional collaboration
Cross-functional communication
Staff development

Full Job Description

JOB DESCRIPTION Job Summary

Provides senior 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

Successfully engages the plan's highest priority, high-volume and strategic complex community providers 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 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 and 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 Medicaid Services (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, including counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise, and 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 (examples include: 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 joint operating committees (JOCs).
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 - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
Serves as a subject matter expert for the provider relations function.
Provides training and support to new and existing provider relations team members.
Role requires 80%+ same-day or overnight travel (extent of same-day or overnight travel will depend on the specific health plan service area).

Required Qualifications

At least 3 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.
Understanding of the health care delivery system, including government-sponsored health plans.
Understanding of 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.
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

Experience in provider services, operations, and/or contract negotiations in a Medicaid, Medicare, and/or Marketplace managed health care setting - ideally with different provider types (i.e. physician, group, hospital).

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

Apply Now

Refine Your Search

senior representative jobs in corona ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)

Customer Service Representative

Director of Sales Enablement

Leasing Consultant LIHTC/Senior Housing - Heritage Villas

Senior Account Executive (Bilingual in English & Mandarin)

Sr. Community Manager - LIHTC & Conventional- Scattered Sites

Financial Professional with Management Opportunity

Senior Project Manager – Restoration & Reconstruction (Residential & Commercial)

Director of Sales & Marketing Hotel

Autism Behavior Interventionist

Frontier Team Member

Senior Quality Engineer

Debt Settlement & Tax Resolution Sales Consultant (Inside Sales Closer)

GRC Senior Security Analyst

New Account Representative

Broker Account Manager

Site Facilitator

Project Manager II

Community Relations Representative

Client Escalation Specialist

I want to receive the latest job alert for senior representative in corona ca

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