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Tribal Liaison (Billing & Claims) Remote in New Mexico

Molina Healthcare Albuquerque, New Mexico; Ruidoso, New Mexico; Grants, New Mexico; Gallup, New Mexico; Santa Fe, New Mexico; Taos, New Mexico; Farmington, New Mexico; Roswell, New Mexico; Hobbs, New Mexico; Las Cruces, New Mexico Job ID 2024839
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Molina Healthcare is hiring in New Mexico for several Billing & Claims, Tribal Liaisons.  
These roles are specifically responsible for working with tribal entities regarding billing and claims support and resolution activities.

Highly qualified candidates will have strong communication skills, excellent Microsoft Office product knowledge, and experience with Native American provider relationship management. 

These roles are remote, candidate must reside in New Mexico, as there may need to travel within the state according to business needs. 

Strong claims knowledge and IHS is required.

Job Summary
Responsible for continuous quality improvements regarding member engagement and member retention.  Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials. 

Knowledge/Skills/Abilities
Assists Molina Healthcare in promoting Native American's access to healthcare coverage and educates communities about the general and value added services provided by Molina Healthcare. Responsible for building and maintaining relationships with tribal community leaders, community-based organizations and providers within tribal lands and reservations through a combination of direct and indirect outreach and engagement activities directed toward building enrollment for all Health Plan lines of business. Establishes formal working relationships with and acts as a central point of contact to the Indian Health Services (IHS) facilities and tribal 638 facilities. Interacts with other Molina Healthcare departments to improve services provided to Native American members, prospective members, IHS and tribal 638 providers. As requested, helps support Molina Healthcare's relationship with IHS and tribal 638 facilities and establishes relationships with tribal employers.

  • Develops liaison engagement strategy to maximize growth opportunities for the Health Plan.
  • Establishes and maintains relationships with assigned providers in tribal communities including Provider outreached (Indian Health Services and 638 Clinics).
  • Achieves net growth goals by assigned territory; measures and tracks productivity.
  • Develops community and school outreach strategies including school-based engagement with key tribal schools; measures and tracks program results.
  • Identifies effective engagement opportunities through key Tribal Governments and TCBOs; measures and tracks results.
  • Serves as primary point of contact to the Native American Community, and other representatives as appropriate.
  • Holds semi-annual meetings with Native American representatives from around the State that represent geographic and member diversity. Minutes of such meetings shall be transmitted to the HSD/MAD within thirty (30) days of such meetings
  • Makes documented efforts to contract with the appropriate urban Indian clinics, Tribally owned health centers, and IHS facilities for the provision of medically necessary services.
  • Ensures that translation services are reasonably available when needed, both in providers' offices and in contacts with the contractor.
  • Ensures appropriate medical transportation for Native American members residing in rural and remote areas for members.
  • Ensures that culturally appropriate materials are available to Native Americans.
  • In-state travel required. 
  • Specialized skills such as claims or billing

Job Qualifications
Required Education:   High School Diploma or GED
Preferred Education: Bachelor's Degree preferred

Required Experience:
3-5 years experience in healthcare industry, preferably in the Medicaid Managed Care Programs
Previous healthcare marketing and/or grassroots/community outreach experience

Preferred Experience:
Experience in the Medicaid Managed Care Programs
Experience with behavioral health and/or coordination of Long-Term Services preferred

Required License, Certification, Association:
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.

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.

Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor, 

#PJHPO

#LI-AC1

Pay Range: $40,851.44 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

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. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 03/16/2024

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