Supervisor, Provider Network Admin - New York, United States - Molina Healthcare

Molina Healthcare

Verified Company

New York, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Remote and must live in New York
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.

Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.

KNOWLEDGE/SKILLS/ABILITIES

Supervises employees responsible for generating and preparing provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/ Inquiry Research & Resolution, Provider Contracting/ Provider Relationship Management).

Responsible for working with plan representatives to ensure quality provider demographics are received.

Educates health plan representatives regarding appropriate provider record set up.

Conducts and documents monthly Provider Network operational meetings.

Works with team members to develop standard reports for audit purposes.

JOB QUALIFICATIONS
Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

Min. 4 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.

3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.

Previous experience organizing or leading people, projects or workflow and demonstrating strong communication skills.

Preferred Education

Bachelor's Degree

Preferred Experience

5+ years managed care experience

QNXT; SQL experience

Crystal Reports for data extraction

Access and Excel - intermediate plus skill level

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:
$40, $88,511.46 / ANNUAL