VP, Encounters (REMOTE)Molina Healthcare Job ID 2006562
Under the general direction of the SVP, Risk, Quality & Encounters Solutions is responsible for the strategy, design, and management of the team that will implement companywide initiatives for Encounters.
• Encounters Accuracy & Completeness (i.e. Encounter Production, Audit, Production Vendor Oversight) for all lines of business. Responsible for increasing volume of encounters received from providers, improve completeness of encounter data with states, CMS, HHS to reconcile data.
• Encounter submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters as well as providing overall organizational leadership aimed at managing overall healthcare costs.
• Hires, coordinates training and manages staff involved in creating controls, documents and tools within the Encounter process in order to manage work in any of the assigned resources.
• Identifies, develops and trains appropriate staff and implements processes to standardize the overall ends-to-end processing, management and accuracy of encounters, as well as working with partner departments to implement process improvements impacting quality and timeliness of encounters processing and accuracy.
• Ongoing monitoring and management resolution for any potential penalties related to accuracy and timeliness of encounters submissions.
• Identifies projects/initiatives that reduce administrative costs for Molina and/or providers as well as identifies opportunities to ensure accurate encounters are occurring to assist in the management of the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Convenes work groups, develops implementation plans with identified tasks, timelines and assigned parties. Executes and measures success.
• Participates with others in the Corporate Operational Leadership Team along with IT to analyze the root cause of information of variations to the encounters, to find/propose ways to improve upon performance results, to identify potential risks to the organization and to lead the needed changes within the encounters process to support the organizational needs in all lines of business.
• Collaborate with leadership, peers, and business partners to establish encounters improvement objectives and execute business priorities based on strategic goals in the operational plan.
• Manages direct Molina staff as well as oversees vendors involved in any of the areas reporting to the VP, Core Operations - Encounters to enable the organization to produce operational results at the lowest possible cost, the most consistent and compliant service levels and the highest level of quality for all lines of business.
• Ensures all state, federal and Molina regulations, Policies/Procedures and SOPs are implemented and followed on a consistent basis to ensure the highest compliance possible within the Corporate Operations areas.
• Sets and manages overall costs to meet/exceed annual budgets and finds ways to improve productivity and automation wherever possible to reduce unit costs and overall G&A for the organization.
• Design and implement systematic approach to improve member and provider experiences through increased operational efficiency and effectiveness.
• Responsible for reporting potential liabilities for financial tracking and accruals to senior leadership.
Bachelor's Degree or equivalent experience
• 10+ years Healthcare or Operational experience in related job.
• 4 years minimum in Director level role or above.
• Accountability for multiple markets or product lines.
• Experience developing and managing department budget within prescribed parameters.
• Experience with account management responsibilities with senior level leadership.
• Excellent verbal and written communication skills.
• Ability to influence and drive change among peers and others within the Molina organization.
• Skill to envision, craft proposals, obtain consensus around approving and implementing future state processes and systems needed to support strategic direction set by organization.
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.
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: 01/21/2021