Job Description

***Remote and must live in Florida***

JOB DESCRIPTION

Job Summary

Leads and manages team responsible 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.

Essential Job Duties
• Oversees team responsible for provider network administration (PNA) activities including updating provider-related information in applicable computer system(s), and provider-related reporting, and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
• Oversees provider network data review/analytics/reporting - ensuring appropriate information has been provided.
• Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment, and establishes, maintains and analyzes internal standard operating policies (SOPs) and procedures.
• Oversees accuracy of provider entry/information into health plan systems.
• Ensures health plan representatives are educated on appropriate provider record set up.
• Collaborates with local and corporate departments to ensure quality provider demographics are received, and resolve issues related to provider loads including, but not limited to, configuration, business systems, encounters (inbound and outbound), Claims, provider services and contracting.
• Identifies PNA issues, resolves problems and implements best practices.
• Conducts and documents monthly provider network administration operational meetings.
• Generates required PNA reporting for leaders and applicable stakeholders.
• Collaborates cross-functionally to develop standard reports for audit purposes.
• Provides support for provider network administration projects.
• Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.

Required Qualifications
• At least 7 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, and at least 3 years of experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes, and 2 years experience in a health plan provider network department, or equivalent combination of relevant education and experience.
• At least 1 year of management/leadership experience.
• Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria experience.
• Strong attention to detail, and ability to ensure accurate data entry/review/delivery
• Strong data analysis skills.
• Strong customer service skills.
• Ability to manage multiple priorities and meet deadlines.
• Ability to work in a cross-functional highly matrixed organization.
• Project management/workflow design experience.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency (including intermediate Excel skills), and applicable software programs proficiency.

Preferred Qualifications
• Query language experience.

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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