Provider Network Administration is responsible for the accurate and timely validation, analysis, maintenance, and governance of critical provider information across claims, credentialing, contracting, and provider network systems. This role serves as a hybrid position focused on supporting provider lifecycle management operations through data analysis, reporting, workflow optimization, system enhancements, and cross-functional coordination.
The role partners closely with Network Operations, IT, PMO, Product Owners, Compliance, and business stakeholders to support operational initiatives, identify process improvement opportunities, enhance reporting capabilities, and improve provider data quality and operational performance.
Essential Job Duties
• Assists in requirement gathering, providing solutions, training users in Salesforce, creating training manuals.
• Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate.
• Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and provider network administration business operations. Report examples may include: GeoAccess availability reports, provider online directory (including ongoing execution, quality assurance and maintenance of supporting tables), Medicare provider directory preparation, and FQHC/RHC reports.
• Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to network management (ER, network access fee, etc.); and mailing label extract generation.
• Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided.
• Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment.
• Ensures accurate entries of information into health plan systems.
• Audits loaded provider records for quality and financial accuracy, and provides documented feedback.
• Develops and maintains documentation and guidelines for all assigned areas of responsibility.
• Assists in resolution of configuration issues with applicable teams.
• Provides support for provider network administration projects.
• Provides training and support to new and existing provider network administration team members.
Required Qualifications
• At least 4 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, or equivalent combination of relevant education and experience.
• Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria.
• Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes,
• Attention to detail, and ability to facilitate accurate data entry/review.
• Data entry/processing skills.
• Customer service skills.
• Ability to manage multiple priorities and meet deadlines.
• Effective verbal and written communication skills.
• Microsoft Office suite (including intermediate Excel skills) and applicable software programs proficiency.
Preferred Qualifications
• Salesforce
• Intermediate to Avanced Excel
• QNXT
• Managed Care background
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
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.
Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
