Manager, Provider Network Administration

_Remote and must live in Florida_ JOB DESCRIPTION Job Summary Leads and manages team responsible 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 Oversees team responsible for provider network administration (PNA) activities including updating provider-related information in applicable computer system(s), and provider-related reporting, and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately. u2022 Oversees provider network data review/analytics/reporting - ensuring appropriate information has been provided. u2022 Maintains department quality standards for provider demographic data with affiliation and fee schedule attachment, and establishes, maintains and analyzes internal standard operating policies (SOPs) and procedures. u2022 Oversees accuracy of provider entry/information into health plan systems. u2022 Ensures health plan representatives are educated on appropriate provider record set up. u2022 Collaborates with local and corporate departments to ensure quality provider demographics are received, and resolve issues related to provider loads including, but not limited to, configuration, business systems, encounters (inbound and outbound), Claims, provider services and contracting. u2022 Identifies PNA issues, resolves problems and implements best practices. u2022 Conducts and documents monthly provider network administration operational meetings. u2022 Generates required PNA reporting for leaders and applicable stakeholders. u2022 Collaborates cross-functionally to develop standard reports for audit purposes. u2022 Provides support for provider network administration projects. u2022 Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. Required Qualifications u2022 At least 7 years of health care experience, to include experience in claims, provider services, provider network operations, and/or hospital/physician billing, and at least 3 years of experience with medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD-9/ICD-10) codes, and 2 years experience in a health plan provider network department, or equivalent combination of relevant education and experience. u2022 At least 1 year of management/leadership experience. u2022 Claims processing experience, including coordination of benefits, subrogation, and/or eligibility criteria experience. u2022 Strong attention to detail, and ability to ensure accurate data entry/review/delivery u2022 Strong data analysis skills. u2022 Strong customer service skills. u2022 Ability to manage multiple priorities and meet deadlines. u2022 Ability to work in a cross-functional highly matrixed organization. u2022 Project management/workflow design experience. u2022 Strong verbal and written communication skills. u2022 Microsoft Office suite proficiency (including intermediate Excel skills), and applicable software programs proficiency. Preferred Qualifications u2022 Query language experience. #PJHPO #LI-AC1 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: $60,415 - $117,809 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-03-07