Director, Provider Network Administration (HP Operations) - Remote in Georgia

Molina Healthcare; Georgia; Remote; USD 97,000 - 190,000; Full time

Job summary

A healthcare company located in Georgia is seeking a leader for their Provider Network Administration team. This role requires a bachelor's degree and a minimum of 7 years of healthcare management experience, preferably in provider network administration. Key responsibilities include ensuring compliance with standards, producing reports, and recruiting new team members. Competitive salary range from $97,299 to $189,732. Molina Healthcare is an Equal Opportunity Employer.

Benefits

Competitive benefits package

Qualifications

• Minimum 7 years of healthcare management experience.
• Previous health plan provider network administration experience required.

Responsibilities

• Lead daily operations of assigned PNA units for compliance.
• Establish and maintain standard operating policies.
• Serve as a partner for provider data issues.
• Produce reports related to provider network information.
• Recruit and train new employees.
• Collaborate on provider load issues across departments.

Skills

Healthcare management

Provider data management

Team collaboration

Education

Bachelor's degree

Master's degree in related field

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

• Oversees/leads the daily operations of assigned Provider Network Administration (PNA) units, ensuring processes are carried out timely, accurately, and in accordance with department, federal and state specific standards.
• Establishes and maintains internal standard operating policies and procedures pertaining to PNA functions and business analyses to ensure alignment with business objectives.
• Serves as Plan level partner to Corporate for contact regarding provider data issues (e.g., provider match error rate) and Configuration issues for claims payment.
• Produces reports related to provider network information.
• Establishes staffing needs and recruits/interviews/hires new employees. Ensures consistent training for staff through the adoption of standardized processes. Ensures timely processing of work while maintaining high performance, professional and collaborative teams.
• Collaborates with Plan and Corporate departments on issues related to provider loads, including but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.

Job Qualifications

Required Education

Bachelor's degree (Associate's degree/High School Diploma and 10+ years relevant experience may substitute)

Required Experience

• Min. 7 years' healthcare management experience.
• Previous health plan provider network administration experience.

Preferred Education

Master's degree in related field

Preferred Experience

• Previous healthcare delivery experience
• Experience with Provider Data Management and Claims Configuration in a managed care environment; system operations, workflow processes and internal controls; NCQA provider data requirements.
• Experience Georgia Managed Care Programs.
• Experience with Managed Care regulations.

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

Pay Range: $97,299 - $189,732.18 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.