Associate Specialist, Provider Network Administrator

Molina Healthcare; San Diego (CA); Remote; USD 100,000 - 125,000; Full time

Job summary

A leading healthcare provider is seeking a Provider Network Administration professional in California. You will be responsible for accurately maintaining critical provider information and ensuring adherence to business requirements. Candidates should have experience in managed care and be detail-oriented. This position is essential in supporting the integrity of provider networks in a dynamic healthcare environment.

Benefits

Competitive benefits package

Equal Opportunity Employment

Qualifications

• Minimum 1 year managed care experience required.
• Preferred 2+ years managed care experience.
• 1+ years in Provider Claims or Network Administration preferred.

Responsibilities

• Validate and maintain provider information in systems.
• Review and analyze data for accuracy.
• Maintain quality standards for provider demographic data.

Skills

Data Analysis

Managed Care

Provider Network Operations

Education

HS Diploma or GED

Associate's Degree or equivalent

Job description

***Remote and must live in California***

Job Description
Job Summary
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
Knowledge/Skills/Abilities
• Receives information from outside parties for update of provider-related information in 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.
• Works on projects as assigned and within parameters given.
• Conducts or participates in special projects as requested..
Job Qualifications

Required Education
HS Diploma or GED
Required Experience
• Min. 1 year managed care experience
• Experience in one of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
Required License, Certification, Association
N/A
Preferred Education
Associate's Degree or equivalent combination of education and experience
Preferred Experience
• 2+ years managed care experience
• 1+ years in Provider Claims and/or Provider Network Administration

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $19.65 - $30.39 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.