19 Administration jobs in Algonac
Manager, Medicare Administration
Posted 1 day ago
Job Viewed
Job Description
**Job Summary**
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services.
**Knowledge/Skills/Abilities**
- Establishes audit controls and measurements to ensure correct processes are established. Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments. Provides post audit findings and recommendations to ensure contractual State and Federal Compliance.
- Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
- Establishes member grievance appeals and policies and updates annually or as directed by the Centers for Medicare and Medicaid Services.
- Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the Center for Medicare and Medicaid.
- Responsible for development, implementation and maintenance of department strategic initiatives.
**Job Qualifications**
**Required Education**
Bachelors Degree
**Required Experience**
5-7 Years
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
7-9 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.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Manager, Medicare Administration
Posted 1 day ago
Job Viewed
Job Description
**Job Summary**
Responsible for the management of the benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate business objectives. Develops infrastructure, standards, and policies and procedures for the Medicare and Dual Eligible Program and participates in the strategic development of its products and services.
**Knowledge/Skills/Abilities**
- Establishes audit controls and measurements to ensure correct processes are established. Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments. Provides post audit findings and recommendations to ensure contractual State and Federal Compliance.
- Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
- Establishes member grievance appeals and policies and updates annually or as directed by the Centers for Medicare and Medicaid Services.
- Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the Center for Medicare and Medicaid.
- Responsible for development, implementation and maintenance of department strategic initiatives.
**Job Qualifications**
**Required Education**
Bachelors Degree
**Required Experience**
5-7 Years
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
7-9 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.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Manager, Provider Network Administration (Remote)
Posted 2 days ago
Job Viewed
Job Description
Job Description
Job Summary
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
Knowledge/Skills/Abilities
-
Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
-
Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
-
Produces reports related to provider network information.
-
Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
-
Identifies issues, resolves problems and implements best practices.
Job Qualifications
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
-
5-7 years managed care experience, including min. 2 years of supervisory experience
-
Min. 2 years health plan Provider Network experience
Required License, Certification, Association
N/A
Preferred Education
Bachelor's Degree
Preferred Experience
-
7+ years managed care experience
-
QNXT; SQL experience
-
Crystal Reports for data extraction
-
Access and Excel - intermediate plus skill level
Preferred License, Certification, Association
N/A
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.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Manager, Provider Network Administration (Remote)
Posted 2 days ago
Job Viewed
Job Description
Job Description
Job Summary
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
Knowledge/Skills/Abilities
-
Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
-
Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
-
Produces reports related to provider network information.
-
Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
-
Identifies issues, resolves problems and implements best practices.
Job Qualifications
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
-
5-7 years managed care experience, including min. 2 years of supervisory experience
-
Min. 2 years health plan Provider Network experience
Required License, Certification, Association
N/A
Preferred Education
Bachelor's Degree
Preferred Experience
-
7+ years managed care experience
-
QNXT; SQL experience
-
Crystal Reports for data extraction
-
Access and Excel - intermediate plus skill level
Preferred License, Certification, Association
N/A
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.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Manager, Provider Network Administration (Remote)
Posted 3 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**Knowledge/Skills/Abilities**
- Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
- Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
- Produces reports related to provider network information.
- Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
- Identifies issues, resolves problems and implements best practices.
**Job Qualifications**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
- 5-7 years managed care experience, including min. 2 years of supervisory experience
- Min. 2 years health plan Provider Network experience
**Required License, Certification, Association**
N/A
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
- 7+ years managed care experience
- QNXT; SQL experience
- Crystal Reports for data extraction
- Access and Excel - intermediate plus skill level
**Preferred License, Certification, Association**
N/A
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.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Manager, Provider Network Administration (Remote)
Posted 3 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**Knowledge/Skills/Abilities**
- Manages all aspects of the Provider Administration area and serves as contact point for all configuration issues to ensure processes are carried out timely and accurately.
- Establishes, maintains and analyzes internal standard operating policies and procedures pertaining to department functions.
- Produces reports related to provider network information.
- Collaborates with local and corporate departments on issues related to provider loads including, but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting.
- Identifies issues, resolves problems and implements best practices.
**Job Qualifications**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
- 5-7 years managed care experience, including min. 2 years of supervisory experience
- Min. 2 years health plan Provider Network experience
**Required License, Certification, Association**
N/A
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
- 7+ years managed care experience
- QNXT; SQL experience
- Crystal Reports for data extraction
- Access and Excel - intermediate plus skill level
**Preferred License, Certification, Association**
N/A
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.
Pay Range: $60,415 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Senior Specialist, Provider Network Administration
Posted 22 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).
+ Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.
+ Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.
+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
+ 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
+ 3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 5+ years managed care experience
+ QNXT; SQL experience
+ Crystal Reports for data extraction
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.
Pay Range: $45,390 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Senior Specialist, Provider Network Administration
Posted 22 days ago
Job Viewed
Job Description
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Generates and prepares provider-related data and reports in support of Network Management and Operations areas of responsibility (e.g., Provider Services/Provider Inquiry Research & Resolution, Provider Contracting/Provider Relationship Management).
+ Provides timely, accurate generation and distribution of required reports that support continuous quality improvement of the provider database, compliance with regulatory/accreditation requirements, and Network Management business operations. Report examples may include: GeoAccess Availability Reports, Provider Online Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports.
+ Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation.
+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
+ 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration.
+ 3+ years' experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 5+ years managed care experience
+ QNXT; SQL experience
+ Crystal Reports for data extraction
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.
Pay Range: $45,390 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Specialist, Provider Network Administration (EST business hours)
Posted 10 days ago
Job Viewed
Job Description
**This role will have standard EST business hours.**
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
+ Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
+ Audits loaded provider records for quality and financial accuracy and provides documented feedback.
+ Assists in configuration issues with Corporate team members.
+ Assists in training current staff and new hires as necessary.
+ Conducts or participates in special projects as requested.
**JOB QUALIFICATIONS**
**Required Education**
Associate degree in Business or equivalent combination of education and experience
**Required Experience**
+ Min. 3 years managed care experience
+ Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
+ Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 3+ years Provider Claims and/or Provider Network Administration experience
+ Experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
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.
Pay Range: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Specialist, Provider Network Administration (EST business hours)
Posted 10 days ago
Job Viewed
Job Description
**This role will have standard EST business hours.**
**Job Summary**
Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.
+ Reviews/analyzes data by applying job knowledge and experience to ensure appropriate information has been provided.
+ Audits loaded provider records for quality and financial accuracy and provides documented feedback.
+ Assists in configuration issues with Corporate team members.
+ Assists in training current staff and new hires as necessary.
+ Conducts or participates in special projects as requested.
**JOB QUALIFICATIONS**
**Required Education**
Associate degree in Business or equivalent combination of education and experience
**Required Experience**
+ Min. 3 years managed care experience
+ Experience in one or more of the following: Claims, Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.
+ Claims processing background including coordination of benefits, subrogation, and/or eligibility criteria.
**Preferred Education**
Bachelor's Degree
**Preferred Experience**
+ 3+ years Provider Claims and/or Provider Network Administration experience
+ Experience in Medical Terminology, CPT, ICD-9 codes, etc.
+ Access and Excel - intermediate skill level (or higher)
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.
Pay Range: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.