Job Description Job Summary Candidates based in TX are highly preferred.
Molina's Credentialing function ensures that the Molina Healthcare provider network consists of providers that meet all regulatory and risk management criteria in order to minimize liability to the company and to maximize safety for members.
Responsible for coordinating assigned provider credentialing and other administrative activities for the state health plan.
Job Duties - Sends standardized form letters notifying providers of credentialing decision within timeframe specified by health plan.
- Updates the credentialing database for all providers after the decision-making portion of the credentialing process. Generates and distributes CACTUS reports as required.
- Answers credentialing questions from providers and internal contacts.
- Researches weekly reports posted by MHI Credentialing to ensure providers submit necessary information to complete the credentialing process.
- Provides monthly report to MHI Credentialing of all providers who have terminated for all lines of business.
- Supports and completes ongoing projects as assigned.
Job Qualifications Required Education: High School Diploma or GED.
Required Experience/Knowledge Skills & Abilities: - Coordinates preparation and routing distribution of documents to complete the contracting/credentialing process in a timely and thorough manner according to standardized process.
- Reviews/Analyses contracts and amendments, including but not limited to fee for Service and Alternative Payment Methods including Pay for Performance.
- Understanding credentialing requirements and regulations.
- Extensive experience using a computer specifically internet research, Microsoft Excel, Microsoft Outlook and Word, and other software systems
- Experience in a production or administrative role requiring self-direction and critical thinking.
- Extensive experience using a computer specifically internet research, Microsoft Outlook and Word, and other software systems.
Preferred Education: Post-high school education in administration or health care.
Experience in the health care industry.
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: $14.9 - $29.06 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.