Specialist, Provider Network Administration (IOWA)

Molina Talent Acquisition; Iowa; On-site; USD 40,000 - 60,000; Full time

Job summary

Molina Healthcare seeks a Provider Network Administrator to support Iowa health plan operations. This role focuses on validating and maintaining provider information across claims and databases to meet business requirements.

You will review data, ensure accurate entries, and assist with network projects, emphasizing attention to detail, data entry, and effective communication with internal teams.

Qualifications

• 3+ years health care experience in claims or provider networks.
• Attention to detail and accurate data entry.
• Data entry/processing skills.
• Strong customer service and communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Receive information from outside parties to update provider data in systems.
• Review/analyze data to ensure accuracy and completeness.
• Maintain 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.
• Assist in resolving configuration issues with applicable teams.
• Provide support for provider network administration projects.

Skills

Data entry

Attention to detail

Customer service

Communication skills

MS Office

Multitasking

Tools

Microsoft Office

Job description

***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