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Long Beach,
CA
(Click company name to view employer profile and all available
positions.) |
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Career Field |
Claims, Claims
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| Insurance
Discipline |
Managed Care
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| Relocation
Assistance |
Not Available
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| Job
Duration |
Full Time |
| Salary
Offered |
Open |
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ABOUT US: Molina Healthcare, Inc., named by Inc. magazine as one of the fastest growing inner city-based companies in the United States, is a multi-state managed care organization that arranges for the delivery of health care services to persons eligible to receive health care benefits through government-sponsored programs for low-income families and individuals. Molina currently serves more than 900,000 members throughout California, Indiana, Michigan, New Mexico, Utah and Washington. Molina’s delivery system provides for a comprehensive approach to good health, including multi-lingual/cultural preventive care, medical care, disease state management and telephonic case management. Molina arranges health care services for members enrolled in its health plans through contracts with health care providers that include the Company’s own clinics, independent physicians and groups, hospitals and ancillary providers.
CLAIMS PROVIDER INFORMATION COORDINATOR
POSITION SUMMARY
Act as a liaison between Molina HealthCare and the Corporate Configuration department. Assist with the coordination of projects; perform data entry functions related to provider information.
Interface with other departments in regards to questions about provider configuration.
Monitor the receipt, analysis and entry of provider information in QNXT Manage modifications and updates to the provider records
Assist claims, Provider Services, Member Service,and the Authorization teams with urgent loading and/or modification of providers and facilities in QNXT
Train Provider Information Coordinators and assist in maintaining training guidelines
Communicate modifications of the provider data base with the Corporate configuration department
Assist Enrollment team by supplying information to do mass member moves and by facilitating month-end reports.
Contact providers – hospitals to get information as needed
Update and distribute the monthly report reflecting all terminations and additions to the provider network
Complete cap group projects and changes as they occur
File completed Spokane and cap group correspondence
Research and respond to inquiries from internal as well as external customers
Perform other duties as assigned.
Complies with required workplace safety standards.
PRINCIPLE ACCOUNTABILITIES
Receive information from outside party(ies) for update of information in computer system(s).
Analyze by applying knowledge and experience to ensure appropriate information has been provided.
Load and maintain provider information into computer system(s) with attention to detail and accuracy in a timely manner to meet department standards of turnaround time and quality.
Audit loaded provider records for quality and financial accuracy and provide documented feedback.
Assist in system/health plan integration.
Training current staff and new hires as necessary.
Assist in system related testing.
Perform other duties as assigned.
JOB REQUIREMENTS:
Education: High School diploma or G.E.D. required. BA Preferred or equivalent experience: 4 to 6 years Managed Care Experience
Basic knowledge of managed care concepts
Computer literate, learn new programs quickly, able to use multiple programs at one time
Strong data entry skills to include proficiency with data
Working knowledge of Microsoft Word, Excel, - or comparable packages
Ability to manage several activities with frequently changing priorities and operate in a high stress environment
Excellent verbal and written communication skills; good listener
Excellent organizational skills; detail-oriented
Medical Terminology helpful
Excellent interpersonal skills; able to interact with peers, supervisors, department associates, providers and vendors
Molina Healthcare is an Equal Opportunity Employer.(EOE). M/F/V/D
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