Supervisor, Provider Network Administration

Molina Healthcare•Long Beach, CA

About The Position

The Supervisor, Provider Network Administration leads and supervises a team responsible for provider network administration activities. The role is responsible for accurate and timely validation and maintenance of critical provider information across claims and provider databases, while ensuring compliance with internal customer business and system requirements in provider network management areas such as provider contracts. The supervisor oversees provider information updates, reporting, data review and analytics, provider record accuracy, and department quality standards. The role maintains and analyzes standard operating policies and procedures, supports health plan representatives in setting up provider records, collaborates across local and corporate departments to resolve provider-load issues, and identifies and addresses operational problems. The supervisor also supports projects, develops audit reporting in collaboration with cross-functional teams, and manages staff through hiring, training, performance evaluation, coaching, development, and recognition.

Requirements

At least 5 years of health care experience, including experience in claims, provider services, provider network operations, and/or hospital or physician billing.
At least 3 years of experience with medical terminology, CPT, ICD-9/ICD-10 codes, or an equivalent combination of relevant education and experience.
Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
Attention to detail and the ability to facilitate accurate data entry, review, and delivery.
Data analysis skills.
Customer service skills.
Ability to manage multiple priorities and meet deadlines.
Workflow design experience.
Effective verbal and written communication skills.
Proficiency with Microsoft Office, including intermediate Excel skills, and applicable software programs.

Nice To Haves

Management or leadership experience.
Query language experience.

Responsibilities

Oversee provider network administration activities, including updating provider information in applicable systems and ensuring provider-related reporting and processes are completed accurately and on time.
Oversee provider network data review, analytics, and reporting to ensure appropriate information is provided.
Maintain department quality standards for provider demographic data, affiliations, and fee schedule attachments; establish, maintain, and analyze internal standard operating policies and procedures.
Oversee the accuracy of provider information entered into health plan systems.
Ensure health plan representatives are educated on appropriate provider record setup.
Collaborate with local and corporate departments to obtain quality provider demographic information and resolve provider-load issues involving configuration, business systems, encounters, claims, provider services, and contracting.
Identify provider network administration issues, resolve problems, and implement best practices.
Conduct and document monthly provider network administration operational meetings.
Generate required provider network administration reports for leaders and applicable stakeholders.
Collaborate cross-functionally to develop standard reports for audit purposes.
Provide support for provider network administration projects.
Hire, train, manage, and evaluate team members; provide coaching, development, and recognition; ensure ongoing staff training; hold regular team meetings; and promote communication and collaboration.