Specialist, Provider Network Administration (FL Healthplan - EST hours)

Molina Healthcare

3d•$18 - $35

About The Position

This position supports Molina's Florida state health plan and will work EST business hours M-F Job Summary Provides 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. • Audits loaded provider records for quality and financial accuracy, and provides documented feedback. • Assists in resolution of configuration issues with applicable teams. • Provides support for provider network administration projects.

Requirements

At least 3 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.
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

Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc.
Intermediate Microsoft Excel skills.

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.
Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
Assists in resolution of configuration issues with applicable teams.
Provides support for provider network administration projects.