Specialist, Provider Network Administration (Remote)

Molina Healthcare

412d • $39,395 - $76,814 • Remote

About The Position

The Specialist in Provider Network Administration is responsible for the validation and maintenance of provider information within claims and provider databases. This role ensures compliance with business and system requirements related to provider network management, including provider contracts, and requires experience in handling provider data.

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.

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.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree