Specialist, Provider Network Administration - Remote

JOB DESCRIPTION

Job Summary

Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.

KNOWLEDGE/SKILLS/ABILITIES

• Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
• Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
• Audits loaded provider records for quality and financial accuracy and provides documented feedback.
• Assists in configuration issues with Corporate team members.
• Assists in training current staff and new hires as necessary.
• Conducts or participates in special projects as requested.

JOB QUALIFICATIONS

Required Education

Associate degree in Business or equivalent combination of education and experience

Required Experience

• Min. 3 years managed care experience
• Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
• Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.

Preferred Education

Bachelor's Degree

Preferred Experience

• 3+ years Provider Claims and/or Provider Network Administration experience
• Experience in Medical Terminology, CPT, ICD-9 codes, etc.
• Access and Excel – intermediate skill level (or higher)
• Credentialing Knowledge

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Originally posted on Himalayas