• Evaluate dispute eligibility and documentation: Analyze claim information to ensure cases meet federal IDR or state-specific dispute requirements before submission. • Research and interpret state regulatory requirements: For state-specific work, independently research state laws, regulations, agency guidance, payer requirements, and arbitration procedures; interpret how they apply operationally; and translate that research into clear, reliable instructions and workflows for the rest of the team. • Own inbox and correspondence review: Monitor shared inboxes and respond to incoming emails from payors and IDR entities, tracking follow-ups and next steps for each case. • Ensure accurate case closures: Confirm disputes are closed only when truly resolved, catching premature or missed closures before they affect reimbursement. • Monitor arbitration timelines and correspondence: Track deadlines and review communications from health plans, arbitration entities, and internal teams to ensure cases progress appropriately. • Maintain operational tracking and documentation: Update internal systems and spreadsheets to maintain accurate case records, dispute statuses, and operational metrics. • Support operational improvements: Contribute to refining workflows and documentation as the team builds more scalable dispute management processes, and flag documentation or system issues to our analytics and product teams when case files are incomplete or inaccurate.

• Serve as a trusted adviser to Sales on Enterprise deal-related matters. • Provide proactive support and guidance to Sales for creative deal structuring, alternative contract options, and value positioning. • Review Order Forms for accuracy, pricing, and compliance; perform to a specified set of metrics and service levels. • Manage the queue and approval process for sales orders, escalating as required. • Work closely with Sales Management, Finance, Legal, and Support teams. • Drive best practices to increase Deal Desk and sales efficiency and effectiveness across the organization, including identifying gaps or process issues. • Analyze and report on transaction trends, efficiency metrics, and areas for improving efficiency. • Deliver relevant training to new and existing salespeople on Deal Desk processes, order procedures, and overall QTC best practices. • Ensure adherence to and compliance with policies and procedures around revenue recognition and operational guidelines.

Role Description Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations. - Reviews coding-related provider claims denials by systematically examining medical records, denial reasons, submitted claims, and claim history, in accordance with applicable state, federal, and Molina guidelines, rules, and protocols, to determine whether the documentation substantiates the services rendered. - Conducts independent audits of non-medical records to verify billing accuracy, making decisions within designated authority to either overturn or uphold denials in a timely manner. - Generates and communicates the determination to the provider using appropriate letter language and providing any necessary guideline links. - Identifies, documents, and communicates any identified coding errors or inconsistencies, collaborating with appropriate internal department(s) to capture and track issues to ensure precise code editing and compliance. - Completes data points within internal applications to comply with auditing requirements used within the departments of Molina. - Actively participates in the enhancement of departmental processes to maintain alignment with current coding regulations and guidelines, while also refining internal procedures. Qualifications - At least 2 years of experience in medical coding or billing. - Active and unrestricted Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification. - Strong attention to detail and ability to independently read and comprehend the details of medical records. - Comfortable working in a production-centric environment with high quality standards. - Ability to use Microsoft Office including Outlook, Word, and Excel. Requirements - To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Estamos em busca de uma pessoa Analista de Qualidade (QA) Pleno para atuar na validação de aplicações das mais diferentes tecnologias como web, mobile e IA. O profissional será responsável por garantir a qualidade do software por meio da definição, execução, automação e acompanhamento das atividades de testes ao longo do ciclo de desenvolvimento. O profissional atuará em colaboração com o time de desenvolvimento e demais stakeholders do projeto. Se você é detalhista, ágil, organizado e curte resolver problemas dos usuários, então, esta oportunidade pode ser para você! Qualifications - Mapear, elaborar, especificar e automatizar casos de teste a partir de requisitos funcionais e técnicos; - Planejar, preparar e executar testes funcionais e exploratórios em aplicações diversas; - Registrar, acompanhar e validar a correção de defeitos identificados durante o ciclo de testes; - Elaborar relatórios de execução de testes e acompanhar indicadores de qualidade; - Trabalhar de forma colaborativa com desenvolvedores e demais membros do time para garantir a qualidade das entregas; - Utilizar ferramentas de gestão de tarefas e defeitos no Azure DevOps/Jira; - Experiência com Engenharia de prompt e uso de IA no seu cotidiano; - Boa organização, comunicação e capacidade de trabalho em equipe; - Contribuir para a melhoria contínua do processo de qualidade do projeto. Requirements - Experiência com automação de testes (ex.: Cypress, Playwright ou similares); - Experiência com testes de API; - Experiência em meios de pagamento; - Conhecimento em ferramentas de gestão e execução de testes; - Conhecimento básico de controle de versionamento com Git; - Ensino Superior Completo na área de Tecnologia da Informação ou áreas correlatas; - Inglês para leitura e escrita; - Certificação ISTQB CTFL. Benefits - Vale alimentação/refeição com valores acima da média de mercado; - Plano médico e odontológico; - Auxílio home office mensal (trabalho remoto ou híbrido); - Licença parental (maternidade - 6 meses; paternidade - 20 dias); - Auxílio creche até 60 meses de idade; - Programa Care4All (rede de apoio à saúde emocional e física); - Wellhub; - Acesso à Conexa Saúde (plataforma online de saúde mental); - Acesso à rede SESC; - Emenda de feriados e recesso de final de ano; - Seguro de vida; - Previdência privada; - Bolsa de estudos, auxílio para certificação e licença da Udemy; - Inglês corporativo (acesso à Voxy ou Michigan); - Acesso à nossa Universidade Corporativa (vnt/school); - PPR; - Guapeco (plano de saúde pet).