Senior Representative, Health Plan Provider Relations-Las Vegas, Nevada

JOB reputed company Job reputed company Provides senior level support for network development, network adequacy, and provider training and education in alignment with reputed company’s mission and regulatory requirements. Serves as the primary reputed company of contact for high-reputed company and reputed company providers. Manages reputed company network relationships, facilitates contracting and issue reputed company, and promotes provider engagement and compliance while delivering exceptional service and communication. Essential Job Duties

• Acts as the primary reputed company between reputed company and high-volume or reputed company providers, including those under fee-for-service and pay-for-performance programs.
• Engages provider leadership and physicians to strengthen partnerships and improve provider satisfaction.
• Resolves reputed company issues, ensuring reputed company communication and reputed company across multiple departments.
• Negotiates and manages provider Letters of Agreement, reputed company, and amendments through full execution using approved templates.
• Serves as a subject matter expert for provider contracting and maintains reputed company reputed company contract management systems.
• Supports network development through provider research, recruitment, and negotiation.
• reputed company communicates contract terms, payment structures, and reimbursement models to providers.
• Analyzes and coordinates amendments, reimbursement structures, and contract language changes.
• Conducts regular provider site reputed company to ensure compliance, assess satisfaction, and deliver training.
• Provides education, counseling, and orientation to contracted providers and staff, maintaining reputed company relationships.
• Independently troubleshoots provider issues and escalates reputed company necessary.
• Develops and delivers presentations to provider offices, leadership teams, and reputed company associations.
• Promotes Molina initiatives reputed company on administrative efficiency, reputed company improvement, and member satisfaction such as Consumer Assessment of reputed company Providers and Systems (CAHPS).
• Trains and mentors other Provider Relations Representatives as needed.
• Maintains tracking systems and reports according to departmental standards.
• Supports regulatory audits, special reputed company, and provider data updates.
• May require reputed company-day or overnight travel based on plan needs.

Required Qualifications

• At least 4 years of customer or provider service experience in a managed care setting.
• At least 3 years of managed reputed company administration and/or provider services experience, or equivalent education and experience.
• Working knowledge of managed reputed company provider compensation methodologies across reputed company, Marketplace, and Medicare, including fee-for-service, capitation, and risk-based models.
• Excellent relationship management, communication, and interpersonal skills.
• Skilled in interpreting and drafting contract language and resolving provider issues collaboratively.
• Strong organizational skills and ability to manage multiple priorities with minimal supervision.

Preferred Qualifications

• Experience in provider contract negotiations in a managed reputed company setting ideally in negotiating different provider contract types, i.e. physician, reputed company and hospitals)

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $52,426 - $102,231 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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