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.
• Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Service team members.
• Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures.
• Forwards requested information/documentation to prospective providers in a timely manner.
• Maintains database of all contracts and specific applications sent to prospective new providers.
• Completes and updates (CIF) form for each new contract.
• Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team.
• Sends out new provider welcome packets to providers who have contracted with the plan.
• Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management.
• Formats and distributes Provider network resources (e.g. electronic specialist directory).
High School Diploma or equivalent GED
1 year customer service, provider service, contracting or claims experience in the healthcare industry.
Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience
Managed Care experience
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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