Mgr, Provider Configuration - QNXT - Remote

$72,371 - $156,803/Yr

Molina Healthcare - Richmond, KY

Full-time

Remote - Richmond, KY

Insurance Carriers and Related Activities

About the position

The Mgr, Provider Configuration - QNXT position at Molina Healthcare is responsible for the accurate and timely maintenance of critical provider information across various claims and provider databases. This role involves synchronizing data among multiple claims systems, validating data for adherence to business and system requirements, and ensuring compliance with contracting, network management, and credentialing processes.

Responsibilities

• Maintain critical provider information on all claims and provider databases.
• Synchronize data among multiple claims systems and apply business rules as they pertain to each database.
• Validate data to be housed on provider databases and ensure adherence to business and system requirements.
• Establish and maintain internal standard operating procedures and enterprise-wide policies related to Provider functions.
• Collaborate with departments on issues related to provider, including Configuration, Business Systems, Encounters, Claims, Provider Services, and Contracting.
• Assist in the design and development of new programs related to transitions and implementations of existing plans regarding provider data.
• Respond to legislative and regulatory developments and audits related to provider information.
• Support others in developing and implementing appropriate Corrective Action Plans for submission of provider network files.
• Act as an expert in handling complaints and escalated issues from internal customers.

Requirements

• Bachelor's Degree or equivalent combination of education and experience.
• 5-7 years of relevant experience.

Nice-to-haves

• Graduate Degree or equivalent combination of education and experience.
• 7-9 years of relevant experience.

Benefits

• Competitive benefits and compensation package.