Offer summary

Qualifications:

High School Diploma or GED required., Provider data validation and auditing experience., Excellent written and verbal communication skills., Proficiency in Microsoft Office and internal systems like QNXT..

Key responsibilities:

Review provider applications and update database accordingly.

Communicate with providers via email to clarify information.

Ensure accurate entry and auditing of provider data.

Assist with system testing and staff training.

Job description

• Will the position be 100% remote?
Yes
• Are there any specific location requirements? candiadtes should be sourced from 1 of the following 15 states-AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI
Must be located in EST
• Are there are time zone requirements?
Yes EST
• What are the must have requirements?

Provider Data validation experience
Provider Data auditing experience

• What are the day to day responsibilities?
Reviewing incoming email/provider applications against primary database to determine if updates are needed, if yes, submit tickets to downstream data entry teams.
Must be comfortable speaking to providers via email, excellent written communication skills.
• Is there specific licensure is required in order to qualify for the role?
No
• What is the desired work hours (i.e. 8am – 5pm)
8-5 EST
• What additional equipment besides a laptop, keyboard, mouse and headset will be required for this candidate to be successful in this role? Dual monitors & docking station

Required Education: High School Diploma or equivalent GED

Summary: This position is responsible for accurately entering provider demographic and contract affiliation information into the health plan system. Must be able to accurately interpret request and enter into the system in such a way that all data is correct and claims adjudication is optimized. Essential Functions: 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. Train current staff and new hires as necessary. Assist in system related testing. Knowledge/Skills/Abilities: Excellent attention to detail Ability to enter information in a timely manner Good project management skills Able to meet deadlines and time constraints Strong knowledge of Microsoft office including Outlook, Word, Excel, and Access Ability to lean internal systems QNXT Excellent verbal and written communication skills Ability to abide by Molinas policies Maintain regular attendance based on agreed-upon schedule Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: High School Diploma or equivalent GED Required Experience: 0-2+ years managed care experiene

Required profile