Collaborates cross-functionally with departments on issues related to provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound ...
Collaborates cross-functionally with departments on issues related to provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound ...
Manager, Provider Configuration
Long Beach, CA · On-site +1
$72K - $156K/yr
... provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound), claims, provider services and contracting. • Assists in design and ...
Manager, Provider Configuration
Long Beach, CA · On-site +1
$72K - $156K/yr
... provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound), claims, provider services and contracting. • Assists in design and ...
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Assists in complex configuration issues and loading of provider information. Generates and distributes network-related compliance, regulatory and accreditation reports. Generates provider-related ...
Assists in complex configuration issues and loading of provider information. Generates and distributes network-related compliance, regulatory and accreditation reports. Generates provider-related ...
Assists in complex configuration issues and loading of provider information. Generates and distributes network-related compliance, regulatory and accreditation reports. Generates provider-related ...
Assists in complex configuration issues and loading of provider information. Generates and distributes network-related compliance, regulatory and accreditation reports. Generates provider-related ...
Analyst, Provider Configuration (Remote)
Long Beach, CA · On-site +1
$49K - $107K/yr
Essential Job Duties • Audits loaded provider records for quality and financial accuracy, and provides documented feedback. • Assists in complex configuration issues and loading of provider ...
Analyst, Provider Configuration (Remote)
Long Beach, CA · On-site +1
$49K - $107K/yr
Essential Job Duties • Audits loaded provider records for quality and financial accuracy, and provides documented feedback. • Assists in complex configuration issues and loading of provider ...
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration (Remote)
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
Associate Analyst, Provider Configuration (Remote)
Long Beach, CA · On-site +1
$16.23 - $35.17/hr
Job Summary Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases.
$37K - $83K/yr
The Configuration Specialist is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and ...
$37K - $83K/yr
The Configuration Specialist is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and ...
Configuration/Data Management Manager
Ridgecrest, CA · On-site
$100K - $150K/yr
Provide configuration management guidance to program managers, engineers, and Government stakeholders. * Ensure compliance with Government, contractual, and program-specific CM/DM requirements.
Configuration/Data Management Manager
Ridgecrest, CA · On-site
$100K - $150K/yr
Provide configuration management guidance to program managers, engineers, and Government stakeholders. * Ensure compliance with Government, contractual, and program-specific CM/DM requirements.
Configuration Management (CM) Specialist Company: Advantech GS Enterprises Location: San Diego, CA ... This role will provide end-to-end CM support across all phases of the acquisition lifecycle ...
Configuration Management (CM) Specialist Company: Advantech GS Enterprises Location: San Diego, CA ... This role will provide end-to-end CM support across all phases of the acquisition lifecycle ...
This role provides direct people leadership for an approximately 8-10-person Configuration Data Management team of individual contributors supporting both hardware and software development and ...
This role provides direct people leadership for an approximately 8-10-person Configuration Data Management team of individual contributors supporting both hardware and software development and ...
This role provides direct people leadership for an approximately 8-10-person Configuration Data Management team of individual contributors supporting both hardware and software development and ...
This role provides direct people leadership for an approximately 8-10-person Configuration Data Management team of individual contributors supporting both hardware and software development and ...
Configuration Analyst, Associate
Rancho Cordova, CA · On-site
$28.34 - $39.67/hr
The QC Configuration Analyst Associate will report to the QC Pricing Analytics Contract ... Validate that the negotiated provider contracts were built correctly and according to the contract ...
Configuration Analyst, Associate
Rancho Cordova, CA · On-site
$28.34 - $39.67/hr
The QC Configuration Analyst Associate will report to the QC Pricing Analytics Contract ... Validate that the negotiated provider contracts were built correctly and according to the contract ...
Serves as the senior plan leader and liaison for corporate operations including: claims, configuration information management, enrollment, support center operations, information technology, provider ...
Serves as the senior plan leader and liaison for corporate operations including: claims, configuration information management, enrollment, support center operations, information technology, provider ...
Serves as the senior plan leader and liaison for corporate operations including: claims, configuration information management, enrollment, support center operations, information technology, provider ...
Serves as the senior plan leader and liaison for corporate operations including: claims, configuration information management, enrollment, support center operations, information technology, provider ...
Director, Configuration
$175K - $216K/yr
A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable ... This position ensures that configuration is accurate, efficient, and designed to function as a ...
Director, Configuration
$175K - $216K/yr
A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable ... This position ensures that configuration is accurate, efficient, and designed to function as a ...
Provider Configuration information
What are the key skills and qualifications needed to thrive as a Provider Configuration Specialist, and why are they important?
To excel as a Provider Configuration Specialist, you need strong analytical abilities, attention to detail, and a background in healthcare administration or related fields. Familiarity with claims processing systems, provider databases, and industry-standard platforms like Facets or QNXT, as well as knowledge of HIPAA regulations, is typically required. Excellent problem-solving skills, communication, and the ability to collaborate across departments help you stand out in this role. These competencies are crucial to ensure accurate provider data management, regulatory compliance, and smooth healthcare operations.
What are some common challenges faced in a Provider Configuration role and how can they be addressed?
Provider Configuration professionals often encounter challenges such as managing large volumes of complex provider data, ensuring timely updates to prevent claim processing errors, and interpreting intricate health plan requirements. Staying organized and detail-oriented is essential to avoid inaccuracies. Collaborating closely with IT, claims, and provider relations teams can help clarify requirements and resolve discrepancies quickly. Leveraging robust data management tools and participating in regular training can also enhance efficiency and accuracy in this role.
What is the difference between Provider Configuration vs Network Administrator?
| Aspect | Provider Configuration | Network Administrator |
|---|---|---|
| Credentials | Certifications like CompTIA Server+, vendor-specific certifications | CompTIA Network+, Cisco CCNA, Microsoft certifications |
| Work Environment | Data centers, cloud platforms, service providers | Office networks, enterprise IT environments |
| Industry Usage | Telecommunications, cloud services, hosting providers | Corporate IT, educational institutions, healthcare |
Provider Configuration specialists focus on setting up and managing service provider systems, often requiring certifications related to cloud and server management. Network Administrators handle network infrastructure within organizations, requiring networking certifications. While both roles involve technical setup, Provider Configuration is more aligned with service provisioning, whereas Network Administrators maintain internal network operations.
What is a Provider Configuration specialist?
A Provider Configuration specialist is responsible for setting up and maintaining healthcare provider information within insurance or healthcare systems. They ensure that provider data such as credentials, contracts, and network participation is accurately entered and updated in databases. This role is crucial for accurate claims processing, payment, and compliance with regulatory requirements. Provider Configuration specialists often work closely with providers, payers, and IT teams to ensure seamless integration and data integrity.
What are popular job titles related to Provider Configuration jobs in California? For Provider Configuration jobs in California, the most frequently searched job titles are:
What job categories do people searching Provider Configuration jobs in California look for? The top searched job categories for Provider Configuration jobs in California are:
Molina Healthcare rating
8.0
Based on 196 frontline employees who took The Breakroom Quiz
160th of 298 rated insurance
Job description
JOB DESCRIPTION
Job Summary
Leads and manages team responsible for provider data management (PDM) activities including analyzing business processes related to PDM, identifying areas for improvement, and developing and implementing solutions to optimize performance. Ensures accurate and timely maintenance of critical provider information for all claims/provider databases, and application of business rules as it pertains to contracting, network management and credentialing.
Essential Job Duties
Establishes and maintains internal standard operating procedures (SOPs), and enterprise-wide policies and procedures pertaining to provider functions - ensuring alignment with business objectives.
Champion a culture of continuous improvement by leveraging automation, artificial intelligence, and emerging technologies to optimize processes and deliver measurable business value.
Collaborates cross-functionally with departments on issues related to provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound), claims, provider services and contracting.
Assists in design and development of new programs as related to transitions and implementations of existing plans with regards to provider data.
Responds to legislative and regulatory developments and audits as it relates to provider information; collaborates cross-functionally to interface with regulators to develop and implement appropriate corrective action plans (CAPs) for submission of provider network files, etc.
Demonstrates expertise in the handling and management of complaints and other escalated issues from internal customers.
Required Qualifications
At least 7 years of experience in provider data management (PDM), including business analytics experience in health care, or equivalent combination of relevant education and experience.
At least 1 year management/leadership experience.
Advanced proficiency in data analysis tools and techniques.
Strong presentation and interpersonal skills, and ability to interact effectively with stakeholders at all levels.
Strong critical-thinking skills, and attention to detail.
Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
Strong verbal and written communication skills.
Microsoft Office suite (including advanced Excel) and applicable software program(s) proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
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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About Molina Healthcare
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980