Manager, Provider Configuration Maintenance - QNXT/Claims - Remote in GA

Molina Healthcare; Boise (ID); Remote; USD 80,000 - 189,000; Full time

Job summary

A leading healthcare organization in Boise, Idaho, is seeking an individual responsible for managing provider information across multiple claims and databases. The candidate should have a Bachelor's Degree and 5-7 years of experience. This position requires collaboration with various departments and an organizational ability to handle regulatory developments. The pay range is $80,412 - $188,164 annually.

Qualifications

• 5-7 years of relevant experience is required.
• 7-9 years of experience preferred.

Responsibilities

• Maintain critical provider information on claims and databases.
• Collaborate with departments on provider-related issues.
• Design and develop new programs related to provider data.
• Respond to legislative and regulatory developments.
• Handle escalated complaints from internal customers.

Skills

Internal standard operating procedures

Collaboration across departments

Organizational expertise

Complaint handling

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent

Job description

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

Knowledge/Skills/Abilities

• Establish and maintain internal standard operating procedures, and enterprise-wide policies and procedures pertaining to Provider functions ensuring alignment with business objectives.
• Collaborate with departments on issues related to provider, including but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
• Assist in design and development of new programs as related to transitions and implementations of existing plans with regards to provider data.
• Organizational expert in responding to legislative and regulatory developments and audits as it relates to provider information. Supports others in facing out to regulators in developing and implementing appropriate Corrective Action Plans for submission of provider network files, etc.
• Act as an expert in handling complaints and other escalated issues from internal customers.

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years

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

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Pay Range: $80,412 - $188,164 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.