Be an early applicantLess than 25 applicantsPosted by Agency

Company

Molina Healthcare · 6 hours ago

Senior Specialist, Provider Network Admin

Troy, MI

Full-time

Remote

Mid, Senior Level

$44K/yr - $89K/yr

3+ years exp

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H1B Sponsor Likely

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Responsibilities

Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).

Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA 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.

Develops and maintains documentation and guidelines for all assigned areas of responsibility.

Qualification

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Managed Care ExperienceProvider Claims AdministrationMedical TerminologyCPT CodingICD-9 CodingAccessExcelQNXTSQLCrystal ReportsProvider Network ManagementDocumentation DevelopmentReport GenerationQuality ImprovementRegulatory Compliance

Required

Bachelor's Degree or equivalent combination of education and experience

3-5 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.

Access and Excel – intermediate skill level (or higher)

Preferred

Bachelor's Degree

5+ years managed care experience

QNXT; SQL experience

Crystal Reports for data extraction

Company

Molina Healthcare

Glassdoor

3.4

Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.

Founded in 1980

Long Beach, California, USA

10001+ employees

https://careers.molinahealthcare.com

H1B Sponsorship

Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (33)

2022 (36)

2021 (33)

2020 (60)