JOB DESCRIPTIONJob SummaryThis position will be supporting the Kentucky and New Mexico Health plansResponsible 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.KNOWLEDGE/SKILLS/ABILITIES
Establish and maintain internal standard operating procedures, and enterprise-wide policies and procedures pertaining to Provider functions ensuring alignment with business objectives.
Collaborate with departments on issues related to provider, including but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
Assist in design and development of new programs as related to transitions and implementations of existing plans with regards to provider data.
Organizational expert in responding to legislative and regulatory developments and audits as it relates to provider information. Supports others in facing out to regulators in developing and implementing appropriate Corrective Action Plans for submission of provider network files, etc.
Act as an expert in handling complaints and other escalated issues from internal customers.
JOB QUALIFICATIONSRequired EducationBachelor's Degree or equivalent combination of education and experienceRequired Experience5-7 yearsPreferred EducationGraduate Degree or equivalent combination of education and experiencePreferred Experience7-9 yearsTo all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Pay Range: $80,412 - $188,164 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
