Medical Coding Dispute Investigator Provides support for provider denial coding dispute activities. Investigates and resolves disputes related to provider appeals, and ensures that claims adhere to correct billing standards and regulations. Essential Job Duties Reviews coding-related provider claims denials
Audit Support For Enterprise Risk Adjustment Provides audit support for Molina enterprise risk adjustment activities. Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organizations risks effects. Identifies and analyzes potential sources
Job Title Leads and manages team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and system
Job Title Manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans identify and track savings opportunities.
Job Title Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. Essential Job
Job Title Provides subject matter expertise and leadership for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers
Business Analyst, Provider Network Molina Healthcare is hiring for a Business Analyst, Provider Network. Highly qualified candidates will have the following experience: Salesforce knowledge, a certification is helpful Managed Care / Healthcare experience in the Provider