Senior Specialist, Provider Network Administration- REMOTE

Molina Healthcare, Inc.; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

Molina Healthcare, Inc. is seeking a senior-level support professional for provider network administration. The role ensures accurate validation and maintenance of critical provider information across claims and provider databases, aligning with contracts and business needs.

The position emphasizes data accuracy, reporting, and documentation, with responsibility for training team members and supporting network administration projects in a dynamic health-care environment.

Qualifications

• 4+ years of health care experience including claims, provider services, or hospital/physician billing.
• Strong attention to detail and accurate data entry.
• Excellent verbal and written communication skills.
• MS Office proficiency with intermediate Excel.
• Ability to manage multiple priorities and meet deadlines.

Responsibilities

• Generates and prepares provider-related data and reports.
• Ensures provider information in systems is accurate and up-to-date.
• Distributes reports supporting quality improvement and regulatory requirements.
• Audits provider records for quality and financial accuracy.
• Maintains documentation and guidelines for responsibilities.
• Provides training and support to team members.

Skills

Health care experience

Customer service

Attention to detail

Data entry

Tools

Excel

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