Senior Specialist, Provider Network Administration- REMOTE

Molina Healthcare; United States; Remote; USD 41,000 - 89,000; Full time

Job summary

Molina Healthcare in the United States seeks a Senior Provider Network Specialist to validate and maintain critical provider information across claims and databases, ensuring accuracy and compliance with business and system requirements for provider contracts.

The role includes generating reports, data quality audits, and supporting network operations with training and documentation to improve efficiency and data integrity in a regulated healthcare environment.

Qualifications

• 4+ years of health care experience including claims, provider services, and/or provider network operations.
• Knowledge of CPT/ICD-9/ICD-10 codes and medical terminology.
• Attention to detail and ability to facilitate accurate data entry and review.
• Data entry/processing skills and strong customer service.
• Ability to manage multiple priorities and meet deadlines.
• Strong verbal and written communication; proficient with Microsoft Office.

Responsibilities

• Generates and prepares provider-related data and reports ensuring provider information is accurate in applicable systems.
• Generates reports to support QI, regulatory/accreditation, and provider network operations, and distributes them timely.
• Audits provider records for quality and financial accuracy and provides feedback.
• Maintains documentation and guidelines for assigned areas of responsibility.
• Provides training and support to new and existing provider network administration team members.

Skills

Attention to detail

Data entry

Customer service

Communication skills

Time management

Verbal communication

Tools

Excel

Microsoft Office

Job description

JOB DESCRIPTION

Job Summary

Provides senior level support for provider network administration activities. Responsible for accurate and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.

Essential Job Duties

• Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate.
• Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and provider network administration business operations. Report examples may include: GeoAccess availability reports, provider online directory (including ongoing execution, quality assurance and maintenance of supporting tables), Medicare provider directory preparation, and FQHC/RHC reports.
• Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to network management (ER, network access fee, etc.); and mailing label extract generation.
• 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.
• Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
• Develops and maintains documentation and guidelines for all assigned areas of responsibility.
• Assists in resolution of configuration issues with applicable teams.
• Provides support for provider network administration projects.
• Provides training and support to new and existing provider network administration team members.

Required Qualifications

• At least 4 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience.
• Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
• Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes.
• Attention to detail, and ability to facilitate accurate data entry/review.
• Data entry/processing skills.
• Customer service skills.
• Ability to manage multiple priorities and meet deadlines.
• Effective verbal and written communication skills.
• Microsoft Office suite (including intermediate Excel skills) and applicable software programs proficiency.

Preferred Qualifications

• Query language experience.

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

Pay Range: $40,851.44 - $88,511.46 / ANNUAL

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