Specialist, Provider Network Admin (Remote in MA)

$33,758 - $73,154/Yr

Molina Healthcare - Boston, MA

Full-time

Remote - Boston, MA

Insurance Carriers and Related Activities

About the position

The Specialist, Provider Network Admin role at Molina Healthcare focuses on the validation and maintenance of critical provider information within claims and provider databases. This position ensures compliance with business and system requirements related to provider network management, including provider contracts, and involves auditing provider records for quality and financial accuracy.

Responsibilities

• Oversee receipt of and coordinate data from the provider network for entry into the plan's provider management system.
• Review and analyze data to ensure appropriate information has been provided.
• Audit loaded provider records for quality and financial accuracy and provide documented feedback.
• Assist in configuration issues with Corporate team members.
• Assist in training current staff and new hires as necessary.
• Conduct or participate in special projects as requested.

Requirements

• Associate degree in Business or equivalent combination of education and experience.
• Minimum 3 years managed care experience.
• Experience in Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
• Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.

Nice-to-haves

• Bachelor's Degree
• 3+ years Provider Claims and/or Provider Network Administration experience.
• Experience in Medical Terminology, CPT, ICD-9 codes, etc.
• Intermediate skill level in Access and Excel or higher.

Benefits

• Competitive benefits and compensation package.