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Specialist, Provider Network Admin- Credentialing (Remote within state of TX) job in Irving at Molina Healthcare

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Specialist, Provider Network Admin- Credentialing (Remote within state of TX) at Molina Healthcare

Specialist, Provider Network Admin- Credentialing (Remote within state of TX)

Molina Healthcare Work from Home/Remote Full-Time

This role will allow remote work provided the selected candidate currently lives within the state of TX


Job Summary

Provider Network Administration is responsible for the accurate and timely credentialing 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.


  • Oversees receipt of and coordinates data from the provider network for entry into the plan's provider management system.

  • Process initial and recredentialing application from providers, meeting departmental requirements.

  • Complete data entry of applications, reviewing them for errors prior to turning in the providers files for quality review.

  • Recredentialing/terminations specialist.

  • 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.


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)

  • Knowledge of NCQA, CMS, and credentialing criteria

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.

Recommended Skills

  • Auditing
  • Cpt Coding
  • Claim Processing
  • Content Management
  • Credentialing
  • Data Entry
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