My Choice Wisconsin is proud to offer a rewarding work. We are looking to hire a Provider Services Representative in Wauwatosa, Wisconsin immediately!
*Applicants for this role must be able to work within our Wauwatosa office as needed and live in Wisconsin.*
Who We Are
Caring Starts Here where we embrace the whole person. We are Wisconsin's largest Managed Care Organization (MCO) that serves seniors and adults with disabilities, making a difference in over 50 counties across the state. My Choice Wisconsin seeks employees that desire to utilize their experience and skills to add value to the organization, and continuously work to learn and grow. With the helping mindset of always keeping our members in mind, My Choice Wisconsin has a strong culture of innovation and collaboration.
What We Offer
A hybrid work environment upon completion of training period
Supported autonomy and collaboration
Opportunities to provide insight into and facilitate process improvement
Workday variety
Growth opportunities throughout the department, My Choice Wisconsin, and Molina Healthcare
Great benefits including 18 days of PTO, paid holidays, a floating holiday, a generous 401(k) program, and insurance programs
What the Provider Services Representative Does
Oversees the provider concern process for the MCO and ensures inquiries from providers and others receive timely and accurate responses.
Provides information and resources internally, to providers, and to the general public regarding contracting processes, policies and procedures.
Maintains, reviews, and responds to Provider Quality Concerns.
Conducts provider visits when severe quality concerns are identified.
Assists the Provider Network Administrator Supervisor to identify trends and establish processes improvement in all aspects of placement and provider concerns.
Works collaboratively with internal teams such as the Residential Team, Provider Network and Relations team, and Care Management staff in communicating provider updates and decisions to various stakeholders.
Serves as a backup to conducting AFH certifications when needed.
Assists the development of new network providers, including determining training needs and developing appropriate, timely technical support materials for incoming providers.
Researches and understands contracts, Wisconsin State Administrative Code and resolve issues in a timely manner.
Compiles and maintains information from the Department of Health Services and Statements of Deficiencies for contracted providers, following up with identified providers as needed.
Leads Provider Quality Advisory Work Group Meetings with the provider network.
Partners with Provider Network Administrator Supervisor to send and analyze the annual provider survey, summarizing results and leading internal meetings to meet DHS requirements on identified initiatives.
Assists with organization of the Provider Quality Newsletter.
Other duties as assigned.
This is a Family Care program.
Minimum Qualifications:
Two or more years of work experience and knowledge of quality, metrics, or related experience.
Bachelor's Degree in a related field.
A valid Driver's License, access to a reliable vehicle, and automobile insurance at the time of hire and throughout employment.
Preferred Qualifications:
Quality Management, Provider Relations, Provider Contracting, or Healthcare experience.
Proficient knowledge and skill using MS Office Products such as Excel, Word, Outlook & PowerPoint.
Strong organizational skills with ability to multitask and prioritize various projects.
Experience using office equipment to photocopy, scan, fax, email.
Molina Healthcare offers competitive benefits and compensation. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $19.84 - $38.69 per hour*
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
