Senior Specialist, Provider Network Administration (Remote)

Molina Healthcare•Long Beach, CT

3d•Remote

About The Position

JOB DESCRIPTION Job Summary Provides senior 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 Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate. Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and provider network administration business operations. Report examples may include: GeoAccess availability reports, provider online directory (including ongoing execution, quality assurance and maintenance of supporting tables), Medicare provider directory preparation, and FQHC/RHC reports. Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to network management (ER, network access fee, etc.); and mailing label extract generation. 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. Audits loaded provider records for quality and financial accuracy, and provides documented feedback. Develops and maintains documentation and guidelines for all assigned areas of responsibility. Assists in resolution of configuration issues with applicable teams. Provides support for provider network administration projects. Provides training and support to new and existing provider network administration team members.

Requirements

At least 4 years 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.
Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes,
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 (including intermediate Excel skills) and applicable software programs proficiency.

Nice To Haves

Query language experience.

Responsibilities

Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate.
Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and provider network administration business operations.
Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to network management (ER, network access fee, etc.); and mailing label extract generation.
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.
Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
Develops and maintains documentation and guidelines for all assigned areas of responsibility.
Assists in resolution of configuration issues with applicable teams.
Provides support for provider network administration projects.
Provides training and support to new and existing provider network administration team members.