Molina Healthcare
Director, Medicare Administration (Regulatory SME) - REMOTE
Molina Healthcare, Lexington, Kentucky, us, 40598
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Director, Medicare Administration
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Molina Healthcare . Job Summary Responsible for managing benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate objectives. Develops infrastructure, standards, policies, and procedures for the Medicare and Dual Eligible Program and participates in strategic development of its products and services. Knowledge/Skills/Abilities Establishes audit controls and measures to ensure correct processes. Develops and performs internal audits/risk assessments, monitoring programs for Molina Healthcare departments. Provides post-audit findings and recommendations to ensure compliance with contractual State and Federal guidelines. Coordinates the development of written policies and procedures regarding compliance with local, state, and federal guidelines. Establishes member grievance and appeals policies, updating annually or as directed by the Centers for Medicare and Medicaid Services. Establishes non-contracted provider dispute and appeals policies, updating annually or as directed by the Centers for Medicare and Medicaid Services. Responsible for development, implementation, and maintenance of department strategic initiatives. Job Qualifications Required Education Graduate Degree or equivalent combination of education and experience. Required Experience 7-9 years. Preferred Experience 10+ years. To all current Molina employees: If interested, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL Actual compensation may vary based on location, experience, education, and skills. Seniority level
Director Employment type
Full-time Job function
Management and Manufacturing Industries
Hospitals and Healthcare
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Director, Medicare Administration
role at
Molina Healthcare . Job Summary Responsible for managing benefits, operations, communication, reporting, and data exchange of the Medicare product in support of strategic and corporate objectives. Develops infrastructure, standards, policies, and procedures for the Medicare and Dual Eligible Program and participates in strategic development of its products and services. Knowledge/Skills/Abilities Establishes audit controls and measures to ensure correct processes. Develops and performs internal audits/risk assessments, monitoring programs for Molina Healthcare departments. Provides post-audit findings and recommendations to ensure compliance with contractual State and Federal guidelines. Coordinates the development of written policies and procedures regarding compliance with local, state, and federal guidelines. Establishes member grievance and appeals policies, updating annually or as directed by the Centers for Medicare and Medicaid Services. Establishes non-contracted provider dispute and appeals policies, updating annually or as directed by the Centers for Medicare and Medicaid Services. Responsible for development, implementation, and maintenance of department strategic initiatives. Job Qualifications Required Education Graduate Degree or equivalent combination of education and experience. Required Experience 7-9 years. Preferred Experience 10+ years. To all current Molina employees: If interested, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $88,453 - $206,981 / ANNUAL Actual compensation may vary based on location, experience, education, and skills. Seniority level
Director Employment type
Full-time Job function
Management and Manufacturing Industries
Hospitals and Healthcare
#J-18808-Ljbffr