Top 200 Business development center representative Jobs in Vista, Ca

Senior Representative, Health Plan Provider Relations (Must Reside in CA)
Molina Healthcare, Inc. —San Marcos, CA
- $73,008 - $111,967 a year
- Full-time
- Medical office experience
- Contracts
- Senior level
- Health insurance
7d
Senior Customer Service Specialist
Abbott Laboratories —Temecula, CA
- $19.35 - $38.75 an hour
- Full-time
- Microsoft Word
- Mid-level
- High school diploma or GED
- Health insurance
- Tuition reimbursement
10d
Junior Internal Sales Representative
AlphaBOLD —Carlsbad, CA
- $30 - $35 an hour
- Full-time
- Hospitality
- Marketing
- Office
- Paid holidays
- Health insurance
Quick Apply
Supervisor, Procurement - IT Procurement
Inland Empire Health Plan —California
- $104,041.60 - $137,841.60 a year
- Full-time
- Hybrid work
- Office
- High school diploma or GED
- Supervising experience
- Disability insurance
- Health insurance
Business Development Center (BDC) Representative
Temecula Valley Toyota —Temecula, CA
- $16.90 - $17.00 an hour
- Full-time
- Bilingual
- Background check
- Sales
- Wellness program
- Paid holidays
Quick Apply
Registered Dental Hygienist-Per Diem
Neighborhood Healthcare —Escondido, CA
- $50.10 - $75.09 an hour
- Part-time
- Spanish
- Dental office
- BLS Certification
- Health insurance
- Dental insurance
Quick Apply
Pest Management Technician
Verde Environmental & Pest Management, Inc —Valley Center, CA
- $22 - $28 an hour
- Overtime
- Background check
- Clean driving record
- Military
- Paid training
- Health insurance
Quick Apply
Senior Land Surveyor
NV5 —San Diego, CA
- $45 - $65 an hour
- Full-time
- Microsoft Word
- Research
- Office
- Health insurance
- Dental insurance
Scientist 3, Analytical Development
Catalent —San Diego, CA
- $115,000 - $125,000 a year
- Email
- Bachelor of Science
- Bachelor's degree
- Doctor of Philosophy
- Paid holidays
- Health insurance
Senior Scientist, Analytical Development, Manager
Catalent —San Diego, CA
- $135,000 - $140,000 a year
- 8 hour shift
- Doctoral degree
- 3 years
- Master's degree
- Paid holidays
- Health insurance
Retail Merchandising Field Specialist
Channel Partners —Escondido, CA
- $18 an hour
- Part-time
- 18 years or older
- Customer service
- Merchandising
- Paid training
- 401(k)
LVN Part Time
Poway Healthcare Center —Poway, CA
- $40 - $44 an hour
- Part-time
- CPR Certification
- Nursing
- LVN
Quick Apply
Supervisor- Front Office
Neighborhood Healthcare —Escondido, CA
- $73,500 - $104,000 a year
- Spanish
- HIPAA
- English
- Health insurance
- Dental insurance
Quick Apply
8d
Patient Services Representative
Vista Community Clinic —Oceanside, CA
- $21.50 - $22.00 an hour
- Part-time
- Spanish
- Computer literacy
- English
- Health insurance
- Dental insurance
Quick Apply
Merchandise Associate
TJ Maxx —Oceanside, CA
- $16.90 - $17.40 an hour
- Part-time
- Merchandising
- Organizational skills
- Fair chance
- Paid parental leave
- Health savings account
Hybrid Customer Service Representative - Operations Team Member
Gateway Services Inc —Temecula, CA
- $19 - $23 an hour
- Overtime
- Hybrid work
- Clean driving record
- High school diploma or GED
- Clinic
- AD&D insurance
- Paid holidays
Quick Apply
10d
Market Development Representative
Sazerac Company —Temecula, CA
- $65,000 - $95,000 a year
- Part-time
- Merchandising
- Driver's License
- Bachelor's degree
Quick Apply
QA Associate I, Manufacturing
Catalent —San Diego, CA
- $60,000 - $70,000 a year
- Email
- Bachelor of Science
- High school diploma or GED
- Entry level
- Paid holidays
- Health insurance
Sr. R&D Shift Operations Supervisor - 1st Shift (Onsite)
Pratt & Whitney —Carlsbad, CA
- $86,800 - $165,200 a year
- Full-time
- 3 years
- Supervising experience
- Bachelor's degree
- Paid holidays
- Disability insurance
10d
Member Services Representative
Exos —Carlsbad, CA
- $16 - $24 an hour
- Part-time
- 1 year
- Phone etiquette
- Communication skills
- Health insurance
- 401(k)
Quick Apply
8d

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

Molina Healthcare, Inc. -
San Marcos, CA

Apply Now

Job Details

Full-time
$73,008 - $111,967 a year
7 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

business development center representative jobs in vista, ca

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

Senior Customer Service Specialist

Junior Internal Sales Representative

Supervisor, Procurement - IT Procurement

Business Development Center (BDC) Representative

Registered Dental Hygienist-Per Diem

Pest Management Technician

Senior Land Surveyor

Scientist 3, Analytical Development

Senior Scientist, Analytical Development, Manager

Retail Merchandising Field Specialist

LVN Part Time

Supervisor- Front Office

Patient Services Representative

Merchandise Associate

Hybrid Customer Service Representative - Operations Team Member

Market Development Representative

QA Associate I, Manufacturing

Sr. R&D Shift Operations Supervisor - 1st Shift (Onsite)

Member Services Representative

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