Senior Specialist, Provider Network Administration (Must reside in Georgia) - Molina Healthcare - Remote in Long Beach, CA, US | Dice.com

Molina Healthcare

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Senior Specialist, Provider Network Administration (Must reside in Georgia)

Remote in Long Beach, CA, US • Posted 30+ days ago • Updated 42 minutes ago

Full Time

On-site

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Job Details

Skills

System Requirements
Research
Relationship Management
Distribution
Quality Improvement
Database
Regulatory Compliance
Business Operations
GeoAccess
Quality Assurance
Medicare
Reporting
Network
Documentation
Network Administration
Medical Terminology
ICD-9
Microsoft Excel
QNXT
SQL
Crystal Reports
Data Extraction
Intranet
Health Care

Summary

Job Description

***Remote and must live in Georgia***

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.

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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Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10121991
Position Id: cbc017d750f30ae1701ae98007e787b9
Posted 30+ days ago

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Senior Specialist, Provider Network Administration (Must reside in Georgia)

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