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.
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
Skills Required
- At least 3 years of health care experience including claims, provider services, provider network operations, or hospital/physician billing
- Claims processing experience including coordination of benefits, subrogation, and/or eligibility criteria
- Attention to detail and ability to facilitate accurate data entry and review
- Data entry and processing skills
- Customer service skills
- Ability to manage multiple priorities and meet deadlines
- Effective verbal and written communication skills
- Proficiency with Microsoft Office suite and applicable software programs
- Experience with medical terminology, CPT, ICD-9/ICD-10 codes
- Intermediate Microsoft Excel skills
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
