Associate Specialist, Provider Network Administration
About The Position
Job Summary Provides entry level support for provider network administration activities. Responsible for accurate and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. Essential Job Duties Receives information from outside parties for update of provider-related information in applicable computer system(s). Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided. Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment. Ensures accurate entries of information into health plan systems. Provides support for provider network administration (PNA) projects. Coordinates preparation and routing distribution of documents to complete the contracting/credentialing process in a timely and thorough manner according to standardized process. Reviews/Analyses contracts and amendments, including but not limited to fee for Service and Alternative Payment Methods including Pay for Performance. Understanding credentialing requirements and regulations.
Requirements
- At least 1 year of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience.
- Attention to detail, and ability to facilitate accurate data entry/review.
- Data entry/processing skills.
- Customer service skills.
- Ability to manage multiple priorities and meet deadlines.
- Effective verbal and written communication skills.
- Microsoft Office suite and applicable software programs proficiency.
Nice To Haves
- 2+ years managed care experience
- 1+ years in Provider Claims and/or Provider Network Administration
- Extensive experience using a computer -- specifically internet research, Microsoft Excel, Microsoft Outlook and Word, and other software systems
Responsibilities
- Receives information from outside parties for update of provider-related information in applicable computer system(s).
- Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided.
- Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment.
- Ensures accurate entries of information into health plan systems.
- Provides support for provider network administration (PNA) projects.
- Coordinates preparation and routing distribution of documents to complete the contracting/credentialing process in a timely and thorough manner according to standardized process.
- Reviews/Analyses contracts and amendments, including but not limited to fee for Service and Alternative Payment Methods including Pay for Performance.
- Understanding credentialing requirements and regulations.
Benefits
- 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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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
