Job Description

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

Essential Job Duties

• Audits loaded provider records for quality and financial accuracy, and provides documented feedback.

• Assists in complex configuration issues and loading of provider information.

• Generates and distributes network-related compliance, regulatory and accreditation reports.

• Generates provider-related reports to facilitate and support provider services and provider issue research and resolution.

Required Qualifications

• At least 2 years of experience in health care, preferably in a customer/provider services setting, or equivalent combination of relevant education and experience.
• Critical-thinking skills, and attention to detail.
• Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Customer service experience.
• Effective verbal and written communication skills
• Microsoft Office suite (including Excel) and applicable software program(s) proficiency.
• Healthcare experience is required.
• Must have an analytical mindset and a prior experience in Provider data configuration.
• Attention to detail, excellent communication and presentation skills are required.
  

Preferred Qualifications

• Prior experience in Claims Processing, QNXT, Appeals & Grievances.

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