Sr Specialist, Provider Network Admin (remote - CA)
Job Description
JOB DESCRIPTION
***EMPLOYEE FOR THIS POSITION MUST RESIDE IN CALIFORNIA****
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.
KNOWLEDGE/SKILLS/ABILITIES
Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).
Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.
Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.
Develops and maintains documentation and guidelines for all assigned areas of responsibility.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.
Access and Excel - intermediate skill level (or higher)
Preferred Education
Bachelor's Degree
Preferred Experience
5+ years managed care experience
QNXT; SQL experience
Crystal Reports for data extraction
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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