Senior Specialist, Provider Network Administration-California

Molina Healthcare • Long Beach, CA

75d • $68,640 - $101,788

About The Position

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.

Requirements

• Bachelor's Degree or equivalent combination of education and experience.
• 3-5 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.
• Intermediate skill level in Excel or higher.
• Provider contracting experience.
• Experience with Sharepoint.

Nice To Haves

• 5+ years managed care experience.
• Experience with QNXT.
• SQL experience.
• Experience with Crystal Reports for data extraction.

Responsibilities

• Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility.
• Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database.
• Ensures compliance with regulatory/accreditation requirements and Network Management business operations.
• Generates GeoAccess Availability Reports, Provider Online Directory, Medicare Provider Directory preparation, and FQHC/RHC reports.
• Generates claims report extractions and regularly scheduled reports related to Network Management.
• Develops and maintains documentation and guidelines for all assigned areas of responsibility.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree