Enable job alerts via email!

Senior Specialist, Provider Network Administration (Remote in UT)

Molina Healthcare

Long Beach (CA)

Remote

USD 70,000 - 90,000

Full time

2 days ago
Be an early applicant

Boost your interview chances

Create a job specific, tailored resume for higher success rate.

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

"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."

Get your free, confidential resume review.
or drag and drop a PDF, DOC, DOCX, ODT, or PAGES file up to 5MB.