Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Director Core Systems Strategies
Location
United States
Posted
6 days ago
Salary
$96.3K - $208.7K / year
Seniority
Lead
No structured requirement data.
Job Description
Director Core Systems Strategies
Molina Healthcare
Role Description Leads and directs 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 requirements as it pertains to contracting, benefits, prior authorizations, fee schedules and other business requirements. - Directs configuration team, and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements. - Strategically plans, leads, and manages configuration workflow processes. - Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals. - Ensures appropriate resources are available to achieve department goals - escalates resource needs, rationale, and deficiencies to leadership. - Identifies and implements strategic process improvements related to the configuration function that demonstrate return on investment (ROI). - Establishes and maintains benefits, provider contracts, fee schedules, claims edits, and other system settings in the claim payment system. - Directs the development and implementation of contract, benefit configuration, and fee schedules. - Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems. - Supports critical business strategies by providing systematic solutions and or recommendations on business processes. - Plans for long-term success of the department and individual health plans - focusing on goals and improvements to daily operations. - Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross-functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives. - Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization. - Utilizes superior judgement in evaluating various approaches to limit risk, and communicates risk accordingly to appropriate stakeholders. - Ensures appropriate follow-up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration. - Ensures team compliance with applicable federal/state regulations and internal policies/procedures. - Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of configuration/department-specific goals. Qualifications - At least 8 years of configuration oversight, claims, auditing, and/or health care operations experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. - At least 3 years of management/leadership experience. - Advanced understanding of claims processes. - Advanced ability to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources. - Strong analytical, critical-thinking, and problem-solving skills. - Strong multitasking ability, and decision-making skills. - Flexibility to meet changing business requirements, and strong commitment to high-quality/on-time delivery. - Ability to work cross-collaboratively in a highly matrixed organization. - High attention to detail. - Excellent verbal and written communication skills. - Microsoft Office suite proficiency, including advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. Preferred Qualifications - Certified Professional Coder (CPC). - Extensive experience leading analysis and operational teams in a managed care setting. - Extensive experience collaborating with various levels of leadership in a highly matrixed organization. - Deep claims system processing, configuration, and queries 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.
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Director, New Business and Product Innovation
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Regional Area Director - Maricopa Regional Area
State of ArizonaThe State of Arizona, otherwise known as "The Grand Canyon State," is one of the "Four Corner States" in the U.S. Home to some of the nation's most popular tourist attractions, suc
Title: Regional Area Director - Maricopa Regional Area Job Description: Job No: 540993 Work Type: Full-time Location: REMOTE OPTIONS,PEORIA Categories: Communication/Community Relations,Social Work/Human Services,Management/Supervisor EARLY CHILDHOOD DEVELOP AND HEALTH BOARD First Things First (Arizona Early Childhood Development and Health Board) is an essential leader and partner in creating a family-centered, equitable, high-quality early childhood system that supports the development, well-being, health and early education of all Arizona's children, birth to age 5. Created by voter initiative in 2006, First Things First is governed by a state Board with 28 regional partnership councils. First Things First is a decentralized organization that engages diverse constituencies to accomplish its mission. 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The Regional Area Director works in coordination with multi-disciplinary support and expertise of the internal FTF teams to develop plans. + Plan for and support the initial and ongoing development of regional council members so they can fulfill their roles and responsibilities more effectively. Increases council members' self-satisfaction for their contributions to advancing the work. Identifies and recruits new council members. + Know and understand the big picture and develop an organized, interrelated network of elements, programs and services that work together for all children. Identify opportunities to leverage resources, infrastructure, capacity building and political relationships in the region. Provide leadership, coordination and collaboration with various early childhood development and health organizations, agencies and community partners in the development and/or support for the local early childhood system in alignment with statewide efforts. 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