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Job Description

Job Summary

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.

Provider Data Governance which is a crucial leadership role responsible for ensuring the end-to-end integrity and accuracy of provider information for seamless member access to healthcare services. This role oversees provider data governance processes critical to effective payer functions such as network contracting, network credentialing, network adequacy, provider directories, and claims processing. The leader is responsible for owning the organizational Provider Data strategy, end-to-end execution of the strategy with collaboration of cross functional partners and overseeing ongoing data governance management processes. The leader must exhibit strong communication, executive presence, and influence skills.

Knowledge/Skills/Abilities

• Oversees/leads the daily operations of assigned Provider Network Administration (PNA) units, ensuring processes are carried out timely, accurately, and in accordance with department, federal and state specific standards.

• Establishes and maintains internal standard operating policies and procedures pertaining to PNA functions and business analyses to ensure alignment with business objectives.

• Serves as Plan level partner to Corporate for contact regarding provider data issues (e.g., provider match error rate) and Configuration issues for claims payment.

• Produces reports related to provider network information.

• Establishes staffing needs and recruits/interviews/hires new employees. Ensures consistent training for staff through adoption of standardized processes. Ensures timely processing of work while maintaining high performance, professional and collaborative teams.

• Collaborates with Plan and Corporate departments on issues related to provider loads, including but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.

Job Qualifications

Required Education

Bachelor's degree or 10+ years relevant experience may substitute.

Required Experience

• Min. 7 years healthcare management experience.

• Previous health plan provider network administration experience.

Preferred Education

Bachelor's or Master's degree in related field.

Preferred Experience

• Previous healthcare delivery experience.

• Experience with provider data management and claims configuration in a managed care environment; system operations, work flow processes and internal controls; NCQA provider data requirements.

To 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: $87,568.7 - $189,732.18 / ANNUAL

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