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 Supervises employees responsible for generating and preparing provider-related data and reports in support of Network Management a... more details
***Remote and must live in New York***
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
Supervises employees responsible for generating and preparing provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/ Inquiry Research & Resolution, Provider Contracting/ Provider Relationship Management).
Responsible for working with plan representatives to ensure quality provider demographics are received.
Educates health plan representatives regarding appropriate provider record set up.
Conducts and documents monthly Provider Network operational meetings.
Works with team members to develop standard reports for audit purposes.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
Min. 4 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
3+ years’ experience in Medical Terminology, CPT, ICD-9 codes, etc.
Previous experience organizing or leading people, projects or workflow and demonstrating strong communication skills.
Preferred Education
Bachelor's Degree
Preferred Experience
5+ years managed care experience
QNXT; SQL experience
Crystal Reports for data extraction
Access and Excel – intermediate plus skill level
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.
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