Specialist, Provider Network Administration (EST business hours)

Molina Healthcare; Macon (GA); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare company located in Georgia is seeking a Provider Network Administrator. The role involves overseeing the timely validation and maintenance of provider information, ensuring adherence to quality standards and assisting in training staff. The ideal candidate should have managed care experience and an Associate degree in Business or a related field. This position offers a competitive benefits package and an hourly pay range of $21.16 - $42.20.

Benefits

Competitive benefits and compensation package

Qualifications

• Minimum 3 years of managed care experience.
• Claims processing background including coordination of benefits.
• Experience in provider claims and/or provider network administration preferred.

Responsibilities

• Oversee data entry into the provider management system.
• Review and analyze provider network data for accuracy.
• Audit provider records for financial accuracy.

Skills

Managed care experience

Claims processing

Provider Network Operations

Data analysis

Education

Associate degree in Business

Bachelor's Degree

Tools

Access

Excel

Job description

Job Summary

Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.

Responsibilities

• Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
• Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
• Audits loaded provider records for quality and financial accuracy and provides documented feedback.
• Assists in configuration issues with Corporate team members.
• Assists in training current staff and new hires as necessary.
• Conducts or participates in special projects as requested.

Qualifications

Required Education

Associate degree in Business or equivalent combination of education and experience

Required Experience

• Min. 3 years managed care experience
• Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
• Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.

Preferred Education

Bachelor's Degree

Preferred Experience

• 3+ years Provider Claims and/or Provider Network Administration experience
• Experience in Medical Terminology, CPT, ICD-9 codes, etc.
• Access and Excel – intermediate skill level (or higher)

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

Pay Range: $21.16 - $42.2 / HOURLY

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