Top 60 Provider relations representative Jobs in South Carolina

Health Plan Provider Relations Representative
Molina Healthcare —Columbia, SC
- $18.85 - $38.69 an hour
- Full-time
- Medical office experience
- Mid-level
- Training & development
- Health insurance
13d
Spa Manager
Hotel Bennett —Charleston, SC
- Weekends as needed
- 18 years or older
- CPR Certification
- 3 years
Quick Apply
Sales Account Manager
Wittenbach Business Systems LLC —Charleston, SC
- Full-time
- Clean driving record
- Marketing
- Mid-level
- Paid training
- Health savings account
Quick Apply
Non-Acute Pharmaceutical Sales Representative
Cardinal Health —South Carolina
- $57,000 - $81,600 a year
- Remote
- Microsoft Outlook
- Mid-level
- Bachelor's degree
- Paid parental leave
- Health savings account
10d
Patient Access Representative - Patient Access
McLeod Health —South Carolina
- Online Application
- Computer literacy
- Medical office experience
- HIPAA
Quick Apply
Sales Representative – Biotech (Entry)
Immune Biopharma —Myrtle Beach, SC
- $88,556 - $118,356 a year
- Online Application
- No travel
- Leadership
- Communication skills
Quick Apply
Assistive Technology Professional
Numotion —Charleston, SC
- Overtime
- Experience working with individuals with disabilities
- Pass drug screening
- Mid-level
- Disability insurance
- Health insurance
Patient Access Specialist - Patient Access
McLeod Health —South Carolina
- Online Application
- Medical office experience
- HIPAA
- Mid-level
Quick Apply
Sr Project Specialist (Sponsor Dedicated/Remote)
サイネオス・ヘルス —South Carolina
- $47,000 - $79,900 a year
- Remote
- English
- Senior level
- Employee stock purchase plan
- Health insurance
6d
General Manager II
Kenco —Rock Hill, SC
- Full-time
- 7 years
- Microsoft Outlook
- Bachelor's degree
- Paid parental leave
- Health savings account
Sales Detail Rep – Pharmaceutical
Immune Biopharma —Mount Pleasant, SC
- $87,090 - $116,890 a year
- Online Application
- Mid-level
- No travel
- Leadership
Quick Apply
Human Resources Generalist
RICHLAND COUNTY RECREATION COMMISSION —Columbia, SC
- $45,000 - $55,000 a year
- Full-time
- Word processing
- Writing skills
- Basic math
3d
Patient Access Representative - Nights 7pm-7am Emergency Department
McLeod Health —Florence, SC
- Online Application
- Computer literacy
- Medical office experience
- HIPAA
Quick Apply
School Ops Administrator
Discovery School at Myrtle Beach —Conway, SC
- Overtime
- Microsoft Word
- School experience
- Inventory management
- 401(k)
Medicaid Fee-For-Service Operations Manager (Program Manager III)
MedImpact Healthcare Systems —Columbia, SC
- $102,260 - $178,955 a year
- Weekends as needed
- Microsoft Outlook
- Computer literacy
- Bachelor of Science
- Paid holidays
- Disability insurance
6d
Practice Liaison / Healthcare Marketing Representative
Carolinas Center for Oral & Facial Surgery —Greenville, SC
- Full-time
- Dental office
- Mid-level
- Recruiting
- Travel reimbursement
- Mileage reimbursement
11d
Clinical Account Executive II
MedImpact Healthcare Systems —Columbia, SC
- $128,974 - $237,313 a year
- Weekends as needed
- 5 years
- Computer literacy
- Basic math
- Paid holidays
- Disability insurance
5d
VIP Host - HOB Myrtle Beach
Live Nation —North Myrtle Beach, SC
- Part-time
- Mid-level
- High school diploma or GED
- Travel
- Adoption assistance
General Manager II
Kenco Logistic Services, LLC —Rock Hill, SC
- Full-time
- 7 years
- Microsoft Outlook
- Bachelor's degree
- Paid parental leave
- Health savings account
Quick Apply
Medicaid Fee-For-Services Systems Manager (Technical Project Manager III)
MedImpact Healthcare Systems —Columbia, SC
- $110,982 - $199,769 a year
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Paid holidays
- Disability insurance
6d

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Health Plan Provider Relations Representative

Molina Healthcare -
Columbia, SC

Apply Now

Job Details

Full-time
$18.85 - $38.69 an hour
13 days ago

Benefits

Health insurance

Qualifications

Customer communication
Managed care
Managed care organization experience
Medical office experience
Schedule management
Health insurance knowledge
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

_*Remote and must live in South Carolina*_

JOB DESCRIPTION

Job Summary

Provides 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 high-volume, high-visibility plan 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 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.
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.).
May provide training and support to new and existing provider relations team members as appropriate.
Role requires 60%+ 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 2 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.
General understanding of the health care delivery system, including government-sponsored health plans.
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

Familiarity with 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.

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: $18.85 - $38.69 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

provider relations representative jobs in south carolina

Health Plan Provider Relations Representative

Spa Manager

Sales Account Manager

Non-Acute Pharmaceutical Sales Representative

Patient Access Representative - Patient Access

Sales Representative – Biotech (Entry)

Assistive Technology Professional

Patient Access Specialist - Patient Access

Sr Project Specialist (Sponsor Dedicated/Remote)

General Manager II

Sales Detail Rep – Pharmaceutical

Human Resources Generalist

Patient Access Representative - Nights 7pm-7am Emergency Department

School Ops Administrator

Medicaid Fee-For-Service Operations Manager (Program Manager III)

Practice Liaison / Healthcare Marketing Representative

Clinical Account Executive II

VIP Host - HOB Myrtle Beach

General Manager II

Medicaid Fee-For-Services Systems Manager (Technical Project Manager III)

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