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

Molina Healthcare; Milwaukee (WI); Remote; USD 80,000 - 189,000; Full time

Job summary

A leading healthcare provider in Milwaukee is seeking a dedicated individual to ensure the accurate maintenance of provider information across databases. The ideal candidate will have 5-9 years of experience in provider functions or related fields and strong organizational skills. Responsibilities include collaborating with various departments and supporting compliance with regulations. This position offers a pay range of $80,412 - $188,164 annually.

Qualifications

• 5-7 years of experience in provider functions or related fields.
• Expertise in developing corrective action plans for provider network files.

Responsibilities

• Maintain accurate and timely provider information across databases.
• Collaborate with departments on provider-related issues.
• Design new programs for managing provider data.

Skills

Organizational skills

Regulatory knowledge

Data validation

Collaboration

Education

Bachelor's Degree

Graduate Degree

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.

#PJCore

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

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