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Molina Healthcare · 21 hours ago

Specialist, Provider Network Administration (FL Healthplan - EST hours)

Florida, United States

Full-time

Onsite

Mid Level

$18.04/hr - $35.17/hr

3+ years exp

Molina Healthcare is a company that supports Florida's state health plan, and they are seeking a Specialist in Provider Network Administration. This role is responsible for maintaining accurate provider information, ensuring compliance with internal requirements, and supporting various provider network administration activities.

Health CareHospitalMedical

Responsibilities

Receives information from outside parties for update of provider-related information in applicable computer system(s)

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

Assists in resolution of configuration issues with applicable teams

Provides support for provider network administration projects

Qualification

Health care experienceClaims processingData entry skillsMicrosoft Office proficiencyCustomer service skillsMultiple priorities managementMedical terminologyMicrosoft ExcelEffective communicationAttention to detail

Required

At least 3 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

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 and applicable software programs proficiency