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Senior Specialist, Provider Network Administration-California
Senior Specialist, Provider Network Administration-CaliforniaCalifornia Staffing • Los Angeles, CA, US
Senior Specialist, Provider Network Administration-California

Senior Specialist, Provider Network Administration-California

California Staffing • Los Angeles, CA, US
4 days ago
Job type
  • Full-time
Job description

Provider Network Administration

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 :

  • Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility.
  • 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.
  • Generates other provider-related reports, such as : claims report extractions; regularly scheduled reports related to Network Management; and mailing label extract generation.
  • Develops and maintains documentation and guidelines for all assigned areas of responsibility.

Job Qualifications :

Required Education : Bachelor's Degree or equivalent combination of education and experience

Required 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.
  • Excel intermediate skill level (or higher)
  • Provider contracting experience
  • Sharepoint
  • Preferred Education : Bachelor's Degree

    Preferred Experience :

  • 5+ years managed care experience
  • QNXT; SQL experience
  • Crystal Reports for data extraction
  • Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

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    Provider Network Specialist • Los Angeles, CA, US

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