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

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.