Specialist, Provider Network Administration (FL Healthplan - EST hours)

Molina Healthcare • Florida, Florida • 2d ago

JOB DESCRIPTION

This position supports Molina's Florida state health plan and will work EST business hours M-F

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.

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.

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

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.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $18.04 - $35.17 / HOURLY

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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