Molina Healthcare

Role Description Provides senior level analyst support for finance activities including financial analysis, reporting, forecasting, trending and modeling to support planning for future business decisions such as new product development, marketing strategies and investments. This position is part of the health plan finance team and supports the financial management of the IL health plan. The individual in this role will assist with the monthly close process, forecasting and budgeting, regulatory reporting, developing financial models, and responding to any ad hoc reporting requests for leadership decision-making support. - Gathers, interprets and evaluates financial information; generating forecasts and analyzing trends in sales, finance and other areas of business. - Financial analysis including budgeting, forecasting, close reporting, and month-end variance analysis. - Complete accurate and timely financial reporting and identify, investigate, and resolve discrepancies. - Uses financial data to evaluate and make recommendations relating to business opportunities, product development, marketing strategies, investments, financial regulations, and similar financial projects or programs. - Forecasts and monitors economic benefits of Molina investments in infrastructure and operations (enhancements in operating efficiency and effectiveness). - Assists the information technology department with financial modeling, budgeting, benchmarking analysis and variance analysis as needed. - Develops policies and procedures to support finance activities. - Ability to prioritize effectively to multi-task under tight deadlines. Qualifications - At least 3 years of finance experience, or equivalent combination of relevant education and experience. - Bachelor’s degree in finance or related field or equivalent combination of education and experience. - Strong critical-thinking and attention to detail. - Ability to effectively collaborate with technical and non-technical stakeholders. - Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Advanced experience Proficient in Microsoft Office suite products, including Excel, PowerPoint (VLOOKUPs and pivot tables), and applicable software program(s) proficiency. Requirements - Strong SQL or Databricks knowledge (technical skills). - Previous finance experience in managed care. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description 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. - Supports implementation and execution of initiatives that include one or all of the following payment integrity activities: - Overpayment recovery - Pre and post-pay coordination of benefits (COB) - Subrogation - Premium enhancement managed service provider (MSP) - Data mining - Pre-pay editing for correct coding and medical payment policies - Supplemental oversight and vendor inventory management processing activities - Hires, trains, develops, mentors, and manages team responsible for executing projects and activities involving: - Inventory management and prioritization - Information reporting - Data management - Quality control procedures and workflows - Timely turnaround - Leads recovery processing, offset reconciliation, refund posting and reconciliation, provider dispute resolution, claim referrals and health plan special projects. - Ensures team meets or exceeds production targets. - Executes payment integrity programs that prioritize, identify and resolve payment/recovery issues. - Establishes procedures and techniques to achieve payment integrity operational standards. - Executes and monitors recovery inventory to ensure maintenance of performance and quality levels in payment integrity business products and processes. - Demonstrates expertise in claims processing, claims payment issue resolution, payment/adjustment error troubleshooting, and quality controls recovery adjustments. - Professionally communicates and responds to health plan/provider inquiries and understands when to escalate issues for resolution as appropriate. - Manages inventory production queues, and assigns and prioritizes work. - Analyzes complex data driven reports and develops actionable insights for resolution and leadership reporting. - Collaborates with payment integrity leadership to resolve recovery issues in collaboration with health plan operations. - Executes tasks and projects to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for: - Pre-pay edits - Overpayment recovery - COB and subrogation Qualifications - At least 5 years of experience supporting health care operations, including 3 years payment integrity/claims experience, or equivalent combination of relevant education and experience. - Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. - Strong organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications - Management/leadership experience. - Managed care payor experience, preferably with Medicare/Medicaid. - Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement. - Electronic medical record (EMR) and medical record repository experience. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes: - Estimating - Scheduling - Costing - Planning - Issue/risk management Qualifications - Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required - 2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable - Additional formal training in PM preferred - PMP or Six Sigma Green Belt Certification desired Requirements - Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach - Solid knowledge of methods and techniques involved in project management initiatives - Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions - Complete mastery of standard applications and project specific software - Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality - Identifies problems and anticipates potential problems - Ability to present alternatives to manage/overcome obstacles - May consult with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action - Projects may have moderate cross functional impact and team organization Benefits - Competitive benefits and compensation package

Role Description Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care. - Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials. - Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately. - Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff. - Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment. - Builds positive relationships between providers and the business by providing coding assistance as needed. - Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education. - Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors. - Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry. Qualifications - At least 2 years medical coding experience, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC). - Certified Coding Specialist (CCS). - Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge. - Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). - Ability to effectively interface with staff, clinicians, and management. - Excellent verbal and written communication skills. - Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Risk Adjustment Coder (CRC). - Certified Professional Payer – Payer (CPC-P). - Certified Coding Specialist – Physician Based (CCS-P). - Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model. - Background in supporting risk adjustment management activities and clinical informatics. - Experience with risk adjustment data validation. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides senior level support for coding activities. Responsible for monitoring adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations. - Provides senior level coding expertise and administrative technical oversight to ensure successful integration of departmental initiatives. - Performs ongoing chart reviews and abstracts diagnoses codes in alignment with the Hierarchical Condition Categories (HCC) model. - Leverages understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted appropriately. - Documents results/findings from chart reviews, and provides feedback to leadership, providers, and office staff. - Creates necessary tools (educational materials, newsletters, etc.) for providers to support risk adjustment. - Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment. - Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to. - Builds positive relationships between providers, and provides coding assistance as needed. - Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education. - Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc. - Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors. - Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership. - Maintains professional and technical coding-related knowledge. Qualifications - At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience. - Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). - Detail-oriented; skilled in medical/clinical documentation review. - Ability to collaborate in a cross-functional highly matrixed organization. - Proven experience partnering with business leaders on training design and execution, instructional design, adult learning theory and deploying training through innovative solutions, and ability to strategically approach development and implementation of clinical education across the enterprise. - Effective verbal and written communication skills, including ability to present to medical professionals. - Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications - Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model. - Background in supporting risk adjustment management activities and clinical informatics. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides entry level analyst support for provider configuration activities including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems and validates data stored within provider databases - ensuring adherence to business and system requirements as it pertains to contracting, network management and credentialing. Qualifications - At least 1 year of experience in health care, preferably in a customer/provider services setting, or equivalent combination of relevant education and experience. - Critical-thinking skills, and attention to detail. - Organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite (including Excel) and applicable software program(s) proficiency. Requirements - Receives provider information from outside parties for loading/update in internal computer systems and databases; analyzes information and applies knowledge, experience, attention to detail and accuracy to ensure appropriate information has been provided and entry is completed timely and accordance with department standards related to turnaround times and quality. - Maintains department standard for loading provider demographic data including affiliation and contract assignment. - Audits loaded provider records for quality and financial accuracy, and provides documented feedback. - Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. Benefits - Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides administrative level support to an Executive and division team members. Prioritizes management/client requests in order to meet business objectives. Supports the day-to-day administrative operations of the Executive and department. - Composes routine executive correspondence - Establishes and maintains official documents and records in appropriate files - Responds to a broad range of inquiries - Keeps executive’s calendar up-to-date - Makes necessary arrangements to ensure details for meetings are completed - Conducts outside research for projects, as necessary - Prepares recurring and special reports and presentations by gathering data, interpreting data and assembling reports using PowerPoint, Excel, etc. for executive’s review and distribution - Proofreads and edits materials - Provides confidential administrative and clerical support to executive - Receives, opens, sorts, reads and prioritizes executive’s mail - Schedules appointments, meetings, conferences, luncheons, hotel reservations and travel plans - Serves as recording secretary for committee(s), scheduling meetings, distributing materials, recording and transcribing meeting minutes Qualifications - High School diploma or equivalent GED - 5-7 years office/clerical experience - 3-5 years experience with Microsoft Office Suite - Business Related Courses (Preferred) - 3-5 years experience in an administrative role (Preferred) Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Fully remote opportunity requiring an active Illinois nursing license. The role operates Monday through Friday from 6:30 AM to 3:00 PM CST and requires prior experience in Utilization Management (UM) and the application of MCG guidelines. Candidates should be comfortable performing utilization reviews and making clinical determinations based on established criteria. Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties - Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. - Analyzes clinical service requests from members or providers against evidence based clinical guidelines. - Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. - Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. - Processes requests within required timelines. - Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. - Requests additional information from members or providers as needed. - Makes appropriate referrals to other clinical programs. - Collaborates with multidisciplinary teams to promote the Molina care model. - Adheres to utilization management (UM) policies and procedures. Qualifications - At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. - Registered Nurse (RN). License must be active and unrestricted in state of practice. - Ability to prioritize and manage multiple deadlines. - Excellent organizational, problem-solving and critical-thinking skills. - Strong written and verbal communication skills. - Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications - Certified Professional in Healthcare Management (CPHM). - Recent hospital experience in an intensive care unit (ICU) or emergency room. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides support for member waiver coordination activities. Contributes to interdisciplinary team efforts supporting provision of integrated delivery of care across the continuum, and overarching strategy to provide quality and cost-effective member care. - Provides non-clinical operational support for member waiver coordination processes. - Facilitates communication between waiver coordination and the state program support unit. - Receives initial state referrals for waiver services and works with long-term services and supports (LTSS) to schedule initial assessment. - Monitors status of initial member assessments, reassessments and transition assessments. - Interfaces with state agency that determines eligibility for LTSS, to process and obtain approval of waiver services. - Monitors transition process of nursing facility members in custodial beds to return to the community. - Initiates referrals for Medicare and waiver process if member is not already Medicare or waiver established. - Tracks referrals and case documents via designated state systems. - Tracks activities occurring within the transitional, assessment and authorization processes - using internal systems and designated state systems, and reports results to accordingly. - Ensures Medicaid and waiver eligibility has been requested and received from state partners before transition/services are initiated. - Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA). - Attends internal meetings and regularly scheduled calls as assigned. Qualifications - At least 1 year of experience in an administrative support role in a health care setting, or equivalent combination of relevant education and experience. - Ability to manage multiple work tasks and prioritize. - Excellent problem-solving skills. - Strong verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Requirements - Certified Medical Assistant (CMA). - Long-term care and/or managed care experience. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Responsible for all the aspects of architecture, design and implementation of Data Management solution using Big Data platform on Cloudera or Hortonworks and other areas of enterprise application platforms. Reporting and analytics are very important for this position. Payment integrity is also important. Please update your resume with any relevant previous experience. - Convert concepts to technical architecture, design and implementation - Provide guidance on choosing ideal Architecture, Evaluating tools and Frameworks, define Standards & Best Practices for implementing scalable business solutions - Implement Batch and Real-time data ingestion/extraction processes through ETL, Streaming, API, etc., between diverse source and target systems with structured and unstructured datasets - Design and build data solutions with an emphasis on performance, scalability, and high-reliability - Code, test, and document new or modified data systems to create robust and scalable applications for data analytics - Build data model for analytics and application layers - Contribute to leading and building a team of top-performing data technology professionals - Help with project planning and scheduling - Expert level experience on Hadoop cluster components and services (like HDFS, YARN, ZOOKEEPER, AMBARI/CLOUDERA MANAGER, SENTRY/RANGER, KERBEROS, etc.) - Ability to participate and lead, in solving technical issues while engaged with infrastructure and vendor support teams. Qualifications - Bachelor's Degree - 5-7 years of data management experience. - Experience in building stream-processing systems, using solutions such as Kafka, Storm or Spark-Streaming. - Proven experience on Big Data tools such as, Spark, Hive, Impala, Polybase, Phoenix, Presto, Kylin, etc. - Experience with integration of data from multiple data sources (using ETL tool such, Talend, etc.). - Experience building solutions with NoSQL databases, such as HBase, Memsql. - Strong experience on Database technologies, Data Warehouse, Data Validation & Certification, Data Quality, Metadata Management and Data Governance. - Experience with programming language such as, Java/Scala/Python, etc. - Experience implementing Web application and Web Services APIs (REST/SOAP). Requirements - Master's Degree (Preferred) - 7-10 years of data management experience (Preferred) - Experience in the healthcare industry is preferred. - Reporting and analytics are very important for this position. - Payment Integrity experience is very important for this opportunity. Benefits Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.