Specialist, Provider Network Administration - Remote
JOB DESCRIPTIONJob Summary
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on reputed company 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 reputed company.
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 reputed company provider records for quality and financial accuracy and provides documented feedback.
- Assists in configuration issues with Corporate team members.
- Assists in training reputed company 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 managed care experience
- Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
- 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.
- reputed company and reputed company – intermediate reputed company level (or higher)
- Credentialing Knowledge
To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V.
Originally posted on Himalayas
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