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Specialist, Provider Network Administration- QNXT


PayCompetitive
LocationLong Beach/California
Employment typeFull-Time

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  • Job Description

      Req#: 300001358776097
      Employer Industry: Managed Care Healthcare

      Why consider this job opportunity:
      - Competitive compensation package with comprehensive benefits
      - Opportunity for career advancement and growth within the organization
      - Engage in meaningful work that supports provider network management
      - Collaborative team environment that encourages professional development
      - Chance to participate in special projects and initiatives

      What to Expect (Job Responsibilities):
      - Oversee the receipt of and coordinate data from the provider network for entry into the provider management system
      - Review and analyze data to ensure accuracy and compliance with business requirements
      - Audit provider records for quality and financial accuracy, providing documented feedback as necessary
      - Assist with configuration issues in collaboration with Corporate team members
      - Train current staff and new hires as needed

      What is Required (Qualifications):
      - Associate degree in Business or equivalent combination of education and experience
      - Minimum of 3 years of experience in provider configuration, setup, and affiliation in QNXT for managed care
      - Experience in Claims, Provider Services, Provider Network Operations, or similar areas
      - Advanced level experience in MS Excel, including Pivot tables and VLOOKUPs for reporting and data analysis
      - Claims processing background, including coordination of benefits and eligibility criteria

      How to Stand Out (Preferred Qualifications):
      - Bachelor's degree in a related field
      - 3+ years of experience in Provider Claims and/or Provider Network Administration
      - Familiarity with medical terminology, CPT, ICD-9 codes, etc.
      - Intermediate skill level in Access and Excel or higher

      #ManagedCare #HealthcareAdministration #ProviderNetwork #CareerGrowth #ExcelSkills

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  • About the company

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