Supervisor, Payment Integrity
Molina Healthcare Arizona; Iowa; Nebraska; Ohio; Georgia; Utah; Idaho; Texas; Kentucky; New York; Washington; Wisconsin; Florida; Michigan; New Mexico; Meridian, Idaho; Miami, Florida; Macon, Georgia; Spokane, Washington; Bowling Green, Kentucky; Orlando, Florida; Owensboro, Kentucky; Yonkers, New York; Idaho Falls, Idaho; Boise, Idaho; Grand Island, Nebraska; Louisville, Kentucky; San Antonio, Texas; Green Bay, Wisconsin; Phoenix, Arizona; Las Cruces, New Mexico; Dayton, Ohio; Caldwell, Idaho; Nampa, Idaho; Augusta, Georgia; Savannah, Georgia; Davenport, Iowa; Provo, Utah; Tampa, Florida; Covington, Kentucky; Rio Rancho, New Mexico; Austin, Texas; Sterling Heights, Michigan; Bellevue, Washington; Roswell, New Mexico; Madison, Wisconsin; Ann Arbor, Michigan; Cincinnati, Ohio; St. Petersburg, Florida; Grand Rapids, Michigan; Buffalo, New York; Scottsdale, Arizona; Iowa City, Iowa; Fort Worth, Texas; Columbus, Ohio; Warren, Michigan; Omaha, Nebraska; Bellevue, Nebraska; Racine, Wisconsin; Rochester, New York; Milwaukee, Wisconsin; Kenosha, Wisconsin; Cedar Rapids, Iowa; Columbus, Georgia; Lincoln, Nebraska; Albuquerque, New Mexico; Santa Fe, New Mexico; Vancouver, Washington; Layton, Utah; Jacksonville, Florida; Lexington-Fayette, Kentucky; Sioux City, Iowa; Houston, Texas; Des Moines, Iowa; New York, New York; Orem, Utah; West Valley City, Utah; Syracuse, New York; Atlanta, Georgia; Kearney, Nebraska; Cleveland, Ohio; Akron, Ohio; Salt Lake City, Utah; Tucson, Arizona; Dallas, Texas; Tacoma, Washington; Mesa, Arizona; Chandler, Arizona; Detroit, Michigan Job ID 2029987
Job Description
Job Summary
Responsible for oversight, production and resolution of Payment Integrity (PI) recovery operations. Execute and monitor recovery inventory to ensure maintenance of performance and quality levels in PI Business products and processes. Establishes procedures and techniques to achieve operational standards. Manages and mentors recovery PI staff to achieve production targets, while supporting the PI manager in resolving recovery issues in collaboration with Health Plan operations.
Knowledge/Skills/Abilities
• With direction from Manager or Director of Payment Integrity, supports implementation and execution of department initiatives that would include one or all of the following PI areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (MSP), Datamining, Pre-pay Editing for correct coding and medical payment policies. Many of these activities include oversight and vendor inventory management/processing that are supplemental to internal processes and recovery activities.
• Manages team members responsible for executing projects and activities involving inventory management and prioritization, information reporting, data management, procedures and workflow to ensure quality controls, and timely turnaround.
• Prioritizes recovery processing, offset reconciliation, refund posting and reconciliation, supports provider dispute resolution, and supports claim referrals and Health Plan special projects.
• Expertise in claims processing to facilitate claim payment issue resolution, troubleshooting payment/adjustment errors, and quality controls recovery specialist adjustment work.
• Great communication skills to respond to Health Plan and Provider inquiries and understands when to escalate issues for resolution where appropriate.
• Manages inventory production queues, assigns and prioritizes work. Ability to analyze complex data driven reports and develop actionable insights for resolution, and management reporting.
• Assists and executes tasks and projects to ensure CMS and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery and COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational and financial outcomes for all PI solutions.
• Executes PI programs that prioritize, identify and resolve payment/recovery issues..
Job Qualifications
Job Summary
Responsible for oversight, production and resolution of Payment Integrity (PI) recovery operations. Execute and monitor recovery inventory to ensure maintenance of performance and quality levels in PI Business products and processes. Establishes procedures and techniques to achieve operational standards. Manages and mentors recovery PI staff to achieve production targets, while supporting the PI manager in resolving recovery issues in collaboration with Health Plan operations.
Knowledge/Skills/Abilities
• With direction from Manager or Director of Payment Integrity, supports implementation and execution of department initiatives that would include one or all of the following PI areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (MSP), Datamining, Pre-pay Editing for correct coding and medical payment policies. Many of these activities include oversight and vendor inventory management/processing that are supplemental to internal processes and recovery activities.
• Manages team members responsible for executing projects and activities involving inventory management and prioritization, information reporting, data management, procedures and workflow to ensure quality controls, and timely turnaround.
• Prioritizes recovery processing, offset reconciliation, refund posting and reconciliation, supports provider dispute resolution, and supports claim referrals and Health Plan special projects.
• Expertise in claims processing to facilitate claim payment issue resolution, troubleshooting payment/adjustment errors, and quality controls recovery specialist adjustment work.
• Great communication skills to respond to Health Plan and Provider inquiries and understands when to escalate issues for resolution where appropriate.
• Manages inventory production queues, assigns and prioritizes work. Ability to analyze complex data driven reports and develop actionable insights for resolution, and management reporting.
• Assists and executes tasks and projects to ensure CMS and State regulatory requirements are met for Pre-pay Edits, Overpayment Recovery and COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational and financial outcomes for all PI solutions.
• Executes PI programs that prioritize, identify and resolve payment/recovery issues..
Job Qualifications
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
3-5 years
Preferred Experience
7+ 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: $77,969 - $128,519 / 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: 01/30/2025ABOUT OUR LOCATION
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