Specialist, Provider Network Admin (Remote in MA)
$33,758 - $73,154/Yr
Molina Healthcare - Boston, MA
posted 28 days ago
Full-time
Remote - Boston, MA
Insurance Carriers and Related Activities
About the position
The Provider Network Administration role is focused on the validation and maintenance of provider information within claims and provider databases. This position ensures compliance with business and system requirements related to provider network management, including provider contracts.
Responsibilities
- Oversee receipt of and coordinate data from the provider network for entry into the provider management system.
- Review and analyze data to ensure appropriate information has been provided.
- Audit loaded provider records for quality and financial accuracy and provide documented feedback.
- Assist in configuration issues with Corporate team members.
- Assist in training current staff and new hires as necessary.
- Conduct or participate in special projects as requested.
Requirements
- Associate degree in Business or equivalent combination of education and experience.
- Minimum 3 years of managed care experience.
- Experience in Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
- Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.
Nice-to-haves
- Bachelor's Degree
- 3+ years of Provider Claims and/or Provider Network Administration experience.
- Experience in Medical Terminology, CPT, ICD-9 codes, etc.
- Intermediate skill level in Access and Excel or higher.
Benefits
- Competitive benefits and compensation package.
