• Specialist, Provider Network Administration- QNXT

    Molina Healthcare (San Jose, CA)


    JOB DESCRIPTION

    Job Summary

    Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.

    KNOWLEDGE/SKILLS/ABILITIES

    + Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.

    + Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.

    + Audits loaded provider records for quality and financial accuracy and provides documented feedback.

    + Assists in configuration issues with Corporate team members.

    + Assists in training current staff and new hires as necessary.

    + Conducts or participates in special projects as requested.

    JOB QUALIFICATIONS

    Required Education

    Associate degree in Business or equivalent combination of education and experience

    Required Experience

    + Min. 3 years in Provider configuration, provider set up and affiliation in QNXT for a managed care experience

    + Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.

    + Advanced level experience in MS Excel (using Pivot tables, Vlookups, data validation etc) for reporting and data analysis.

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

    Preferred Education

    Bachelor's Degree

    Preferred Experience

    + 3+ years Provider Claims and/or Provider Network Administration experience

    + Experience in Medical Terminology, CPT, ICD-9 codes, etc.

    + Access and Excel – intermediate skill level (or higher)

     

    To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

     

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

     

    Pay Range: $20.74 - $40.44 / HOURLY

     

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