Mgr, Encounter Data -Remote
Company: Molina Healthcare
Posted on: September 19, 2022
- KNOWLEDGE/SKILLS/ABILITIES The Manager, Encounter Data
oversees and monitors claims & encounters processes, including
partnering with cross-functional teams (Plan or MHI) to prevent
encounter rejections via root cause analysis and resolution. This
role can be worked remotely from a variety of locations. -
Healthcare background, specifically- Health Insurance background in
Encounters, Claims, Medicare, Data, Risk Adjustment, and/or
Configuration is highly desired. Additional duties may include the
- Monitors and/or assigns encounter workflow queues; ensures
volume and aging are current.
- Oversees researching of claims or encounters for
benefits-related issues & proposed solutions via claims,
benefit/contract and provider configuration, eligibility related
- Monitors State, Federal and/or third-party agency submissions,
contractual compliance, and SLAs.
- Works closely with other departments in the alignment of
internal claims and encounter edits and external rejections.
- Monitors and/or oversees projects across all teams/departments
to address corrections, changes, and updates to assure encounter
- Works with various leadership levels internally and across
departments with respect to encounter status(es), reporting,
coordination with Government Relations and the distribution of
information that affects encounter process, submission, and
acceptance. JOB QUALIFICATIONS Required Education: High School
diploma or GED Preferred Education: College Degree or equivalent
work experience of 7 to 10 years in a senior level position
associated with claims and/or encounter processing Required
Experience: 10 years or more of managed care experience Preferred
Experience: Claims processing, Provider contacting, Health data
analysis and reporting, project management, working with various
levels of management throughout multiple organizations 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. Same Posting Description for Internal and External
Keywords: Molina Healthcare, Oxford , Mgr, Encounter Data -Remote, Other , Brooksville, Mississippi
Didn't find what you're looking for? Search again!