Specialist, Provider Network Administration

Molina Healthcare; Salt Lake City (UT); On-site; USD 55,000 - 75,000; Full time

Job summary

Molina Healthcare in Salt Lake City is seeking a detail-oriented provider network administrator to support the maintenance of provider data across claims and related databases. You will validate information, review updates, and ensure entries comply with business rules.

The role emphasizes accuracy, timely updates, and effective collaboration with internal teams on provider contracts and network operations.

Qualifications

• 3+ years of health care experience including claims, provider services, provider network operations, or equivalent
• Experience with claims processing including coordination of benefits, subrogation, and eligibility criteria
• Attention to detail and ability to facilitate accurate data entry/review
• Customer service skills and ability to manage multiple priorities and meet deadlines
• Proficiency with Microsoft Office and related software programs

Responsibilities

• Receives information from outside parties for update of provider-related information in applicable system(s).
• Reviews data to ensure accurate information has been provided.
• Maintains provider demographic data with affiliation and fee schedule attachments.
• Ensures accurate entries of information into health plan systems.
• Audits loaded provider records for quality and financial accuracy, and provides feedback.
• Assists in resolution of configuration issues with applicable teams.
• Provides support for provider network administration projects

Skills

Data entry

Attention to detail

Customer service

Multitasking

Communication skills

Tools

Microsoft Office

Job description

JOB DESCRIPTION Job Summary

Provides 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

• Receives information from outside parties for update of provider-related information in applicable computer system(s).
• 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.
• Assists in resolution of configuration issues with applicable teams.
• Provides support for provider network administration projects.

Required Qualifications

• At least 3 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.
• 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 and applicable software programs proficiency.

Preferred Qualifications

• Intermediate Microsoft Excel skills.

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