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Specialist, Provider Network Admin

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Molina Healthcare

22d ago

  • Job
    Full-time
    Mid & Senior Level
  • Data
    Business, Operations & Strategy
  • Long Beach

AI generated summary

  • You need a Bachelor's degree or equivalent, 3-5 years in managed care (2+ in Provider Claims/Network), 3+ years in medical terminology, and intermediate Access/Excel skills.
  • You will generate and distribute provider-related reports, maintain the provider database, ensure compliance, and develop documentation for Network Management and Operations functions.

Requirements

  • 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

Responsibilities

  • - 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.

FAQs

What is the primary role of the Specialist, Provider Network Admin?

The primary role is to accurately and timely validate and maintain critical provider information on all claims and provider databases, ensuring adherence to business and system requirements.

What type of experience is required for this position?

The position requires 3-5 years of managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration, as well as 3+ years of experience in Medical Terminology, CPT, and ICD-9 codes.

What skills are necessary for this job?

Necessary skills include intermediate level proficiency in Access and Excel, as well as the ability to generate and prepare provider-related data and reports.

Is a specific degree required for the Specialist, Provider Network Admin position?

A Bachelor's Degree or an equivalent combination of education and experience is required for the position.

What kind of reports will I be generating in this role?

You will generate reports such as GeoAccess Availability Reports, Provider Online Directory reports, Medicare Provider Directory preparation, claims report extractions, and other Network Management related reports.

Are there any preferred qualifications for this job?

Yes, preferred qualifications include 5+ years of managed care experience, experience with QNXT, SQL knowledge, and familiarity with Crystal Reports for data extraction.

What is the pay range for this position?

The pay range for the Specialist, Provider Network Admin position is $16.23 - $35.17 per hour.

Does the company offer benefits?

Yes, Molina Healthcare offers a competitive benefits and compensation package.

Is this position open to current Molina employees?

Yes, current Molina employees interested in applying for this position should do so through the intranet job listing.

Is this role subject to regulations regarding provider information?

Yes, the role involves ensuring compliance with regulatory/accreditation requirements related to provider information and database management.

Molina Healthcare

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.