Provider Relations Representative Jobs in USA with Visa Sponsorship
Provider Relations Representatives work in healthcare administration coordinating between insurers, hospitals, and medical networks. Employers in managed care and health systems regularly sponsor H-1B visa and TN visas for qualified candidates with degrees in healthcare administration, public health, or business. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsJOB 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 10% 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
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 10% 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
See all 56+ Provider Relations Representative Jobs
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Get Access To All JobsTips for Finding Provider Relations Representative Jobs
Target managed care and health plan employers
Large health insurers and managed care organizations file Labor Condition Applications for Provider Relations roles far more frequently than smaller clinics. Focus your search on employers with established HR infrastructure and a track record of sponsoring work visas.
Align your degree to the specialty occupation standard
H-1B approval depends on showing the role requires a specific bachelor's degree. Degrees in healthcare administration, public health, or business administration are the strongest fit for Provider Relations positions and support the specialty occupation argument most directly.
Highlight network contracting and credentialing experience
Employers sponsoring visas want candidates who reduce onboarding risk. Concrete experience with provider credentialing, contract negotiation, or claims resolution signals immediate value and strengthens the business case a hiring manager must make to justify sponsorship.
Understand TN eligibility if you hold Canadian or Mexican citizenship
TN visa classification covers certain business and management roles under USMCA. If your degree is in a qualifying field like business administration, TN may be available without the H-1B lottery, giving you a faster path to starting work.
Address the specialty occupation question proactively
Provider Relations is a role USCIS scrutinizes for H-1B eligibility. Come prepared to explain why your specific position requires a degree in a particular field, not just any bachelor's degree, using your job description and employer documentation as evidence.
Build experience in health information systems
Familiarity with systems like Epic, Facets, or similar provider management platforms strengthens your profile significantly. Employers sponsoring visas are especially motivated when candidates bring technical skills that are harder to source domestically on short timelines.
Frequently Asked Questions
Do employers commonly sponsor visas for Provider Relations Representative roles?
Sponsorship exists but is more common at large managed care organizations, regional health plans, and hospital networks than at smaller practices. Employers with dedicated HR and legal teams are better positioned to navigate H-1B visa filings. You can browse sponsoring employers currently hiring on Migrate Mate to identify which organizations have active openings.
Does a Provider Relations Representative role qualify as an H-1B specialty occupation?
It can qualify, but USCIS scrutinizes administrative healthcare roles closely. The key is demonstrating that the specific position requires a degree in a particular field, such as healthcare administration or public health, not just any bachelor's degree. Job descriptions that list specific degree requirements and employers who document this requirement in writing have stronger petition outcomes.
What degrees support an H-1B or work visa petition for this role?
Healthcare administration, public health, business administration, and health informatics are the most defensible degree fields for Provider Relations positions. A general business or communications degree can work if the employer's job description ties the role's duties directly to that field of study. The degree-to-job match is the core of the specialty occupation argument.
Can a Canadian citizen get a TN visa for a Provider Relations Representative position?
Possibly, if the role fits a covered TN category and your degree aligns. Management consultant or certain scientific or business analyst categories have been used for healthcare administrative roles, but TN classification requires a clear match between the USMCA category, the job duties, and your credentials. An immigration attorney can assess your specific situation before you apply.
What should I expect during the H-1B petition process for this type of role?
Your employer files a Labor Condition Application with the Department of Labor first, then submits Form I-129 to USCIS after the H-1B lottery selection. For administrative healthcare roles, USCIS sometimes issues Requests for Evidence challenging specialty occupation status. Having a detailed job description, an employer support letter explaining degree requirements, and documentation of your credentials reduces the risk of delays.
What is the prevailing wage requirement for sponsored Provider Relations Representative jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.