Provider Configuration Management Specialist

2 weeks ago

Georgetown, United States Molina Healthcare Full time
Job Summary

This position will support the Kentucky and New Mexico Health plans by ensuring accurate and timely maintenance of critical provider information on all claims and provider databases. The successful candidate will be responsible for maintaining critical provider information, synchronizing data among multiple claims systems, and applying business rules as they apply to each database. Additionally, they will 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.

Key Responsibilities

• 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.
• Organize and respond to legislative and regulatory developments and audits as it relates to provider information.
• Support 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.

Requirements

• Bachelor's Degree or equivalent combination of education and experience.
• 5-7 years of experience.
• Preferred Education: Graduate Degree or equivalent combination of education and experience.
• Preferred Experience: 7-9 years.

About Molina Healthcare

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range:
$72, $156,803.45 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.

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