AVP, Payment Integrity
Molina Healthcare Arizona; Iowa; Augusta, Georgia; Savannah, Georgia; Boise, Idaho; Grand Rapids, Michigan; Ann Arbor, Michigan; Albuquerque, New Mexico; Yonkers, New York; Austin, Texas; Provo, Utah; Orem, Utah; Spokane, Washington; Bellevue, Washington; Madison, Wisconsin; Mesa, Arizona; Orlando, Florida; Nampa, Idaho; Owensboro, Kentucky; Omaha, Nebraska; Santa Fe, New Mexico; Dayton, Ohio; Layton, Utah; Tacoma, Washington; Green Bay, Wisconsin; Phoenix, Arizona; Idaho; Jacksonville, Florida; Columbus, Georgia; Macon, Georgia; Warren, Michigan; Rio Rancho, New Mexico; Cincinnati, Ohio; Houston, Texas; San Antonio, Texas; Dallas, Texas; Tucson, Arizona; Tampa, Florida; Meridian, Idaho; Sioux City, Iowa; Louisville, Kentucky; Kearney, Nebraska; Roswell, New Mexico; Utah; Washington; Scottsdale, Arizona; Miami, Florida; Cedar Rapids, Iowa; Detroit, Michigan; Grand Island, Nebraska; Las Cruces, New Mexico; Syracuse, New York; Chandler, Arizona; Idaho Falls, Idaho; Caldwell, Idaho; Iowa City, Iowa; Sterling Heights, Michigan; Bellevue, Nebraska; Cleveland, Ohio; Akron, Ohio; West Valley City, Utah; Michigan; Nebraska; Texas; Milwaukee, Wisconsin; Kenosha, Wisconsin; Florida; St. Petersburg, Florida; Des Moines, Iowa; Davenport, Iowa; Covington, Kentucky; Lincoln, Nebraska; Buffalo, New York; Rochester, New York; Columbus, Ohio; Salt Lake City, Utah; New Mexico; New York; Vancouver, Washington; Racine, Wisconsin; Atlanta, Georgia; Lexington-Fayette, Kentucky; Bowling Green, Kentucky; New York, New York; Fort Worth, Texas; Kentucky; Ohio; Georgia Job ID 2029862
Job Description
Job Summary
Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve
Knowledge/Skills/Abilities
• Strategizes and leads the implementation of companywide initiatives relevant to Corporate Payment Integrity which would include one or all of the following areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (such as ESRD and Medicare Secondary Payer) and Pre-pay Editing for correct coding and medical payment polices. Many of these activities include oversight of vendors that are supplemental to internal processes and activities.
• Leads activities supporting the production of claims and future call volume for the above which has a downstream impact on the Corporate Claims Compliance Team, Finance, Support Services, Encounters, SIU, Health Plans and the Provider community.
• Initiates strategic changes with IT and other departments for business processes and systems for Corporate Payment Integrity.
• Leads the implements Corporate Configuration of the COB tables and Claims edits logic in the QNXT system as well as Recovery.Net Management application which provides significant cost savings for both medical and Rx expenses.
• Ensures CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational and financial outcomes for all solutions..
Job Qualifications
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
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.
Job Summary
Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve
Knowledge/Skills/Abilities
• Strategizes and leads the implementation of companywide initiatives relevant to Corporate Payment Integrity which would include one or all of the following areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (such as ESRD and Medicare Secondary Payer) and Pre-pay Editing for correct coding and medical payment polices. Many of these activities include oversight of vendors that are supplemental to internal processes and activities.
• Leads activities supporting the production of claims and future call volume for the above which has a downstream impact on the Corporate Claims Compliance Team, Finance, Support Services, Encounters, SIU, Health Plans and the Provider community.
• Initiates strategic changes with IT and other departments for business processes and systems for Corporate Payment Integrity.
• Leads the implements Corporate Configuration of the COB tables and Claims edits logic in the QNXT system as well as Recovery.Net Management application which provides significant cost savings for both medical and Rx expenses.
• Ensures CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational and financial outcomes for all solutions..
Job Qualifications
Required Education
Graduate Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
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: $140,795 - $274,550.26 / 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: 01/28/2025ABOUT OUR LOCATION
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