Specialist, Provider Network Administration (IOWA)
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What you'll do
- 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.
What they're looking for
- 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.
- 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.
Nice to have
- Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9, ICD-10) codes, etc.
- Intermediate Microsoft Excel skills.
- Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
***Candidates based in IOWA are highly preferred.***
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.
This team supports our IOWA Healthplan.
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.
• 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.
- Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
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
Company
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