• Senior Specialist, Provider Network Administration

    Molina Healthcare (Detroit, MI)


    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. This multifaceted role supports both operational efficiency and strategic project delivery for process improvement initiatives as it pertains to other provider network management areas.

    KNOWLEDGE/SKILLS/ABILITIES

    + Bridge communication and collaboration between IT, PMO, provider network teams and business end users to align objectives and drive coordination of project delivery activities

    + Serve as a business user partner in IT development, providing requirements, input on solution/UI design, and leading user acceptance testing.

    + Lead efforts in identifying and analyzing workflow inefficiencies, recommend process improvements, and collaborate with cross-functional teams to design and implement optimized solutions that enhance operational performance and productivity.

    + Deliver customer-focused support and training to ensure smooth project delivery, successful adoption and effective utilization of implemented solutions

    + Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).

    + Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.

    + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.

    + Develops and maintains documentation and guidelines for all assigned areas of responsibility.

    JOB QUALIFICATIONS

    Required Education

    Bachelor's Degree or equivalent combination of education and experience

    Required Experience

    + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.

    + 3+ years’ experience in Salesforce User Interface is required.

    + Experience in User Acceptance Testing is required (UAT).

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

    Preferred Education

    Bachelor's Degree

    Preferred Experience

    + 5+ years managed care experience

    + QNXT

    + Crystal Reports for data extraction

     

    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: $77,969 - $106,214 / ANNUAL

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