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Mgr, Encounter Data -Remote

Company: Molina Healthcare
Location: Normal
Posted on: September 24, 2022

Job Description:

- 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 following:

  • 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 errors, etc.
  • 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 submission acceptance.
  • 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 Candidates #PJHPO

Keywords: Molina Healthcare, Huntsville , Mgr, Encounter Data -Remote, Other , Normal, Alabama

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