Specialist, Provider Network Administration (IOWA)

Molina Healthcare; Iowa; Hybride; USD 22 000 - 48 000; Plein temps

Résumé du poste

Molina Healthcare is seeking a provider data support specialist with a focus on Iowa health plan operations. You will help validate and maintain provider information across claims and databases, ensuring accuracy and compliance with internal requirements.

The role emphasizes data entry precision, attention to detail, and strong communication with internal teams. Prior health plan experience and proficiency with Microsoft Office are preferred.

Qualifications

• At least 3 years of health care experience in claims, provider services, provider network operations, or equivalent.
• Attention to detail and ability to facilitate accurate data entry and review.
• Data entry/processing skills and strong customer service orientation.
• Effective verbal and written communication skills.
• Proficient in Microsoft Office and applicable software programs.

Responsabilités

• Receive information from outside parties for provider data updates in systems.
• Review and analyze data to ensure completeness and accuracy.
• Maintain quality standards for provider demographic data with affiliation and fee schedules.
• Ensure accurate entries of information into health plan systems.
• Audit provider records for quality and financial accuracy and provide feedback.
• Support provider network administration projects and resolve configuration issues with teams.

Connaissances

Health care experience

Data entry

Customer service

Attention to detail

Communication skills

Microsoft Office

Outils

Microsoft Excel

Description du poste

Candidates based in IOWA are highly preferred.

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.

This team supports our IOWA Healthplan.

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.
• 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

• Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc.
• Intermediate Microsoft Excel skills.

• Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.

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

Pay Range: $16.23 - $35.17 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.