Senior Specialist, Provider Network Administration (Remote in UT)

Molina Healthcare; Long Beach (CA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider seeks a Network Management Specialist to enhance provider database accuracy and engage in impactful healthcare delivery tasks. The role requires a Bachelor's degree and managed care expertise, offering opportunities for growth within a supportive environment focused on compliance and quality improvement.

Benefits

Competitive benefits and compensation package

Opportunity for career advancement

Supportive work environment

Qualifications

• 3-5 years of managed care experience required.
• 2+ years in Provider Claims or Network Administration preferred.
• Intermediate level skills in Access and Excel.

Responsibilities

• Generate and prepare provider-related data and reports.
• Ensure compliance with regulatory requirements through accurate reporting.
• Execute quality assurance on provider directories.

Skills

Medical Terminology

CPT Coding

ICD-9 Codes

Data Management

Provider Network Administration

Quality Assurance

Report Generation

Education

Bachelor’s Degree

Tools

Access

Excel

QNXT

SQL

Crystal Reports

Job description

Employer Industry: Managed Care

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive benefits and compensation package
- Work in a supportive environment focused on compliance and quality improvement
- Engage in critical provider network management tasks that impact healthcare delivery
- Chance to make a significant contribution to provider database accuracy and operations

What to Expect (Job Responsibilities):
- Generate and prepare provider-related data and reports to support Network Management and Operations
- Provide timely and accurate reports to ensure compliance with regulatory requirements and business operations
- Develop and maintain documentation and guidelines for assigned responsibilities
- Execute quality assurance and maintenance of supporting tables for provider-related directories
- Conduct claims report extractions and generate mailing labels as needed

What is Required (Qualifications):
- Bachelor’s Degree or equivalent combination of education and experience
- 3-5 years of managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration
- 3+ years of experience in Medical Terminology, CPT, ICD-9 codes, etc.
- Intermediate skill level or higher in Access and Excel

How to Stand Out (Preferred Qualifications):
- 5+ years of managed care experience
- Experience with QNXT and SQL
- Proficiency in Crystal Reports for data extraction

#ManagedCare #HealthcareAdministration #ProviderNetwork #CareerGrowth #DataManagement

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