Job Details

Job Summary

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validates data to be housed on provider databases and ensures adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

Knowledge/Skills/Abilities

Strategically plans, leads, and manages the overall Provider Information process functions.

Directs the development, implementation and maintenance of provider data in the claims payment system.

Supports critical business strategies by providing systematic solutions and or recommendations on business processes.

Organizational expert in responding to legislative and regulatory developments and audits as it relates to provider information. Supports others in facing out to regulators in developing and implementing appropriate Corrective Action Plans for submission of provider network files, etc.

Engages with IT and other departments to implement changes to business processes and systems for Corporate Operations PMO.

Job Qualifications

Required Education Graduate Degree or equivalent combination of education and experience

Required Experience 7-9 years

Preferred Education Graduate Degree or equivalent combination of education and experience

Preferred Experience 10+ years

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.

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Pay Range: $97,299 - $227,679 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.