Director, Payment Integrity (Analytics)

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Job Description

Job Summary

Responsible for planning, developing and directing the implementation of techniques to ensure the maintenance of performance and quality levels in the Business' products and processes. Reviews operation process designs and establishes procedures and techniques for operational standards. Confers with customers to define and resolve.

Knowledge/Skills/Abilities

Lead a team that has responsibility for Content Ideation, Research and Edit Development teams in support of our cross-functional Payment Integrity organization

Responsible for oversight of concept development / refinement & root cause analysis team to drive content optimization / minimize dispute overturn rates. Utilize algorithms and models to mine big data, improve models, and ensure data uniformity and accuracy.

Develop scalable, efficient, and automated processes for large-scale data analyses and model development.

Demonstrated critical thinking and ability to bring order to unstructured problems.

Works independently, demonstrates initiative and innovative thinking, clear and concise communication skills.

Identifies technical improvements needs to expand concept ideation: connection with new databases, report monitoring, BOTs/Automation, etc.

Proven ability to coach, develop and engage strong teams. Hires, trains, coaches, counsels and evaluates performance of direct reports.

Team management Performance review of team members at regular intervals

Continuing to drive positive operational and financial outcomes within the other Provider Payment Initiatives

Required Experience

• Rich understanding of claim reimbursement across all Medical spend types and both State & Federal reimbursement methodologies / guidelines
• Technical experience / understanding of data systems and edit configuration, such as SQL, Python, Power BI/Tableau, Databricks, etc.
• Minimum of 5 years related experience in Claims, Analytics or Payment Integrity related job functions
• 5 years Managed Care payor experience, preferably Medicare / Medicaid experience.
• 3 years of experience in a leadership role; demonstrated success in managing / leading teams
• Excellent verbal and written communication skills
• Excellent organizational and people management skills
• Ability to influence and drive change among peers and others within the Molina organization
• Ability to maintain standards to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
  
  

Required Education

Bachelor Degree or equivalent combination of education and experience

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $97,299 - $227,679 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.