Molina Healthcare
JOB DESCRIPTION
If you are considering sending an application, make sure to hit the apply button below after reading through the entire 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 issues. KNOWLEDGE/SKILLS/ABILITIES Implements companywide initiatives relevant to Claims Production, including Claims Production, Audit, and Production Vendor Oversight. Leads activities supporting claims production, including the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, and Corporate Encounter Team, and provides organizational leadership of claims editing and recovery vendors to manage healthcare costs. Collaborates with IT and other departments to implement changes to business processes and systems within the Corporate Operations PMO. Implements Corporate Configuration of the QNXT system and the Care Management application for UM functions within QNXT, ensuring system produces expected costs. Ensures compliance with state regulatory requirements, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and drives positive operational and financial outcomes across initiatives. 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. Current Molina employees interested in this position should apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $140,795 - $274,550 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.
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If you are considering sending an application, make sure to hit the apply button below after reading through the entire 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 issues. KNOWLEDGE/SKILLS/ABILITIES Implements companywide initiatives relevant to Claims Production, including Claims Production, Audit, and Production Vendor Oversight. Leads activities supporting claims production, including the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, and Corporate Encounter Team, and provides organizational leadership of claims editing and recovery vendors to manage healthcare costs. Collaborates with IT and other departments to implement changes to business processes and systems within the Corporate Operations PMO. Implements Corporate Configuration of the QNXT system and the Care Management application for UM functions within QNXT, ensuring system produces expected costs. Ensures compliance with state regulatory requirements, maximizes MASS Adjudication within QNXT, improves process quality, reduces G&A costs, and drives positive operational and financial outcomes across initiatives. 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. Current Molina employees interested in this position should apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $140,795 - $274,550 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.
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