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Program Manager, Health Plan Payment Integrity (Claims & Recovery) Remote
Molina Healthcare
Remote, USA
Full-time
Manager · 5+ years experience
Remote
Discovered 1 weeks ago
Full Job Posting
Required Qualifications
- At least 5 years of business analyst experience in a managed care organization (MCO), and at least 3 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience. • Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity. • Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. • Strong data analysis/queries experience, and ability to analyze data to inform business decisions. • Strong business judgment, cross-functional coordination, and ownership of high-value deliverables. • Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment. • Strong written and verbal communication skills, including ability to synthesize complex information. • Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.
- At least 5 years of business analyst experience in a managed care organization (MCO), and at least 3 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
- Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
- Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
- Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
- Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
- Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
- Strong written and verbal communication skills, including ability to synthesize complex information.
- Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.
Preferred Qualifications
- Experience with Medicare, Medicaid, and/or Marketplace lines of business. • Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification. • Project management experience. • Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
- To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
- Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
- Project management experience.
- Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
- To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
- Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
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