Top 1664 Member services representative Jobs in Nebraska

Senior Representative, Health Plan Provider Relations - Remote Must reside in NE
Molina Healthcare —Nebraska
- $47,433.00 - $97,362.61 a year
- Full-time
- Remote
- Medical office experience
- Contracts
- Senior level
- Health insurance
1d
Licensed Practical Nurse
UroHealth Partners —Omaha, NE
- Full-time
- Nursing
- Medical office experience
- BLS Certification
- Health savings account
- Health insurance
Quick Apply
Executive Director
Box Butte Development Corporation —Alliance, NE
- $65,000 - $72,000 a year
- Full-time
- Bachelor's degree
- Mentoring
- US work authorization
- Health insurance
- Paid time off
Quick Apply
2d
Registered Nurse Pre-Op/PACU
Southwest Lincoln Surgery Center —Lincoln, NE
- $34.00 - $37.75 an hour
- Full-time
- Background check
- CPR Certification
- Nursing
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse
UroHealth Partners —Omaha, NE
- Full-time
- Nursing
- RN License
- Medical office experience
- Health savings account
- Health insurance
Quick Apply
Pharmacy Customer Service Representative I
ONEWORLD COMMUNITY HEALTH CENTERS INC —Omaha, NE
- Full-time
- 18 years or older
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Armed Security Officer Dedicated Site
Signal of Lincoln —Lincoln, NE
- $20 an hour
- Part-time
- Background check
- Clean driving record
- Customer service
- Paid training
- Tuition reimbursement
Quick Apply
Regional Director of Brand Services
Cobblestone Hotels —Omaha, NE
- From $65,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Management
- Health insurance
- Dental insurance
Quick Apply
12d
Outside Sales Representative
SPECTRUM —Columbus, NE
- $25,100 - $41,000 a year
- Weekends as needed
- English
- Mid-level
- Office
- Opportunities for advancement
10d
Collector
Gatestone & Co Inc —Omaha, NE
- From $18.50 an hour
- Urgently hiring
- 1 year
- Communication skills
- Entry level
- Disability insurance
- Health insurance
Quick Apply
Director of Clinical Services
Southwest Nebraska Public Health Department —Ogallala, NE
- $25 - $35 an hour
- Full-time
- Management
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply
9d
Part Time - Registered Nurse
Milan Laser Hair Removal —Lincoln, NE
- Part-time
- Mid-level
- Communication skills
- Continuing education credits
- 401(k) matching
Quick Apply
9d
FSQA Tech 3rd Shift
Universal Pure, LLC —Lincoln, NE
- From $20 an hour
- Full-time
- Basic math
- English
- Mid-level
Quick Apply
Warehouse Office Clerk
Southshore Enterprises, Inc. —York, NE
- From $19 an hour
- Overtime
- Bilingual
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
Youth Facilities Senior Administrator
Nebraska Department of Health and Human Services —Kearney, NE
- From $150,000 a year
- Weekends as needed
- Residential
- Master's degree
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
5d
First Impressions Representative
Stonebridge Wealth Systems, LLC —Grand Island, NE
- $20 - $22 an hour
- Full-time
- Background check
- Google Workspace
- Computer literacy
- Health savings account
- Health insurance
Quick Apply
7d
Outside Sales Representative-Surfaces
Richelieu Hardware —Omaha, NE
- 5 years
- Mid-level
- Ability to lift 50 pounds
- Employee stock purchase plan
- Paid holidays
Quick Apply
Route Sales Representative
Hawkins Inc —Roca, NE
- $60,000 - $70,000 a year
- Call employer
- Computer literacy
- Basic math
- DOT physical examination
- Paid training
- Employee stock purchase plan
Quick Apply
Property Representative
FBL Financial Group, Inc. —Sidney, NE
- Driver's License
- Travel
- US work authorization
- Paid holidays
- Disability insurance
2d
Vibration Data Technician
C&W Services —Blair, NE
- $17.64 - $20.75 an hour
- 8 hour shift
- Customer service
- 5 years
- Forklift
- Health savings account
- Disability insurance
Quick Apply

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Senior Representative, Health Plan Provider Relations - Remote Must reside in NE

Molina Healthcare -
Nebraska

Apply Now

Job Details

Full-time
$47,433.00 - $97,362.61 a year
1 day 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
Medicaid regulations
Medicaid
Productivity software
Healthcare reimbursement methods
Cross-functional collaboration
Cross-functional communication

Full Job Description

JOB DESCRIPTION Job SummaryProvides 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

Pay Range: $47,433 - $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

member services representative jobs in nebraska

Senior Representative, Health Plan Provider Relations - Remote Must reside in NE

Licensed Practical Nurse

Executive Director

Registered Nurse Pre-Op/PACU

Registered Nurse

Pharmacy Customer Service Representative I

Armed Security Officer Dedicated Site

Regional Director of Brand Services

Outside Sales Representative

Collector

Director of Clinical Services

Part Time - Registered Nurse

FSQA Tech 3rd Shift

Warehouse Office Clerk

Youth Facilities Senior Administrator

First Impressions Representative

Outside Sales Representative-Surfaces

Route Sales Representative

Property Representative

Vibration Data Technician

I want to receive the latest job alert for member services representative in nebraska

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