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

Molina Healthcare; City of Rochester (NY); Remote; USD 80,000 - 189,000; Full time

Job summary

A healthcare management company in Rochester is seeking an expert to maintain critical provider information on claims and databases. Responsibilities include data validation, establishing operating procedures, and collaboration across departments. A Bachelor's degree and 5-7 years of experience in provider functions are required. This role offers a competitive salary range of $80,412 - $188,164 annually.

Qualifications

• 5-7 years of relevant experience.
• Experience in provider functions and data management.
• Experience with regulatory audits and compliance.

Responsibilities

• Maintain provider information on claims and provider databases.
• Establish internal procedures and policies.
• Assist in designing new programs related to provider data.

Skills

Organizational expertise in provider data

Knowledge of legislative and regulatory requirements

Collaboration across departments

Education

Bachelor's Degree

Graduate Degree (preferred)

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.