Mgr, Provider Data Management
Molina Healthcare Arizona; Caldwell, Idaho; Covington, Kentucky; Layton, Utah; Cleveland, Ohio; Detroit, Michigan; Davenport, Iowa; Dallas, Texas; Provo, Utah; Santa Fe, New Mexico; Columbus, Georgia; Iowa City, Iowa; Grand Island, Nebraska; Cedar Rapids, Iowa; Meridian, Idaho; Racine, Wisconsin; Fort Worth, Texas; Grand Rapids, Michigan; Phoenix, Arizona; Atlanta, Georgia; Idaho Falls, Idaho; Idaho; Tucson, Arizona; Jacksonville, Florida; Wisconsin; Madison, Wisconsin; Buffalo, New York; Michigan; Tampa, Florida; Yonkers, New York; Syracuse, New York; Seattle, Washington; Florida; Salt Lake City, Utah; New York, New York; Iowa; Vancouver, Washington; Texas; Orem, Utah; Bowling Green, Kentucky; Sioux City, Iowa; Mesa, Arizona; Scottsdale, Arizona; Warren, Michigan; Orlando, Florida; St. Petersburg, Florida; Spokane, Washington; Green Bay, Wisconsin; Columbus, Ohio; Georgia; Utah; Dayton, Ohio; Owensboro, Kentucky; Augusta, Georgia; Bellevue, Washington; Louisville, Kentucky; New York; Ohio; New Mexico; Sterling Heights, Michigan; West Valley City, Utah; Roswell, New Mexico; San Antonio, Texas; Rio Rancho, New Mexico; Cincinnati, Ohio; Nampa, Idaho; Kearney, Nebraska; Lexington-Fayette, Kentucky; Albuquerque, New Mexico; Nebraska; Washington; Tacoma, Washington; Macon, Georgia; Bellevue, Nebraska; Savannah, Georgia; Lincoln, Nebraska; Las Cruces, New Mexico; Milwaukee, Wisconsin; Rochester, New York; Des Moines, Iowa; Boise, Idaho; Houston, Texas; Omaha, Nebraska; Kenosha, Wisconsin; Chandler, Arizona; Ann Arbor, Michigan; Kentucky; Akron, Ohio; Austin, Texas; Miami, Florida Job ID 2029315JOB DESCRIPTION
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. 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.
KNOWLEDGE/SKILLS/ABILITIES
- 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 data migrations and implementations of new or existing plans with regards to provider data.
- Experience in developing business requirement to support automated processed.
- 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.
- Act as an expert in handling complaints and other escalated issues from internal customers.
- Experience in monitoring daily inventory levels related to provider data updates, ensuring service level agreements are achieved as well as quality measurements; managing production and non-production staff to ensure targets are met.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5+ years industry experience with Medicaid, Medicare and or Market Place operations,
Preferred Experience
2+ years managing provider data, QNXT experience
 2+ years management experience. Â
Pay Range: $80,412 - $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 01/16/2025ABOUT OUR LOCATION
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