Senior Specialist, Provider Network Administration (...

JOB DESCRIPTION Job Summary Provides senior level support for provider network administration activities. Responsible for accurate and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. Essential Job Duties u2022 Generates and prepares provider-related data and reports, and ensures provider information in applicable computer system(s) is accurate. u2022 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. u2022 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. u2022 Reviews/analyzes data by applying job knowledge to ensure appropriate information has been provided. u2022 Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment. u2022 Ensures accurate entries of information into health plan systems. u2022 Audits loaded provider records for quality and financial accuracy, and provides documented feedback. u2022 Develops and maintains documentation and guidelines for all assigned areas of responsibility. u2022 Assists in resolution of configuration issues with applicable teams. u2022 Provides support for provider network administration projects. u2022 Provides training and support to new and existing provider network administration team members. Required Qualifications u2022 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. u2022 Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria. u2022 Experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes, u2022 Attention to detail, and ability to facilitate accurate data entry/review. u2022 Data entry/processing skills. u2022 Customer service skills. u2022 Ability to manage multiple priorities and meet deadlines. u2022 Effective verbal and written communication skills. u2022 Microsoft Office suite (including intermediate Excel skills) and applicable software programs proficiency. Preferred Qualifications u2022 Query language experience. 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 Pay Range: $49,930 - $97,363 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-02-23