Senior Specialist, Provider Network Administration (Salesforce)

JOB DESCRIPTION 

Job Summary

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