Senior Specialist Provider Network Administrati...

@ Molina Healthcare

Job Summary

The Senior Specialist Provider Network Administration California is responsible for the accurate and timely validation and maintenance of critical provider information on claims and provider databases. This role supports internal customers with adherence to business and system requirements, especially in provider contracts and other network management areas.

Knowledge/Skills/Abilities

The candidate will:

• Generate and prepare provider-related data and reports supporting Network Management and Operations.
• Provide timely, accurate generation and distribution of reports for quality improvement, compliance, and operational needs.
• Maintain ongoing execution, QA, and maintenance of supporting tables for various directories and reports.
• Generate additional reports such as claims extraction, regularly scheduled network management reports, and mailing label extracts.
• Develop and maintain documentation and guidelines for assigned areas.

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 in Medical Terminology (CPT, ICD-9 codes, etc.), intermediate or higher Excel skills, and provider contracting experience. Knowledge of Sharepoint is required.

Preferred Education: Bachelor's Degree.

Preferred Experience: 5+ years managed care experience, experience with QNXT, SQL, and Crystal Reports for data extraction.

Additional Information

Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer (M/F/D/V). Current Molina employees are encouraged to apply via the intranet job listing.

Key skills/competency

Provider Data, Report Generation, Network Management, Compliance, Medical Terminology, Excel, SharePoint, SQL, QNXT, Crystal Reports