Director, Payment Integrity

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

• With direction from the VP or AVP of Payment Integrity, leads the implementation of companywide initiatives that would include one or all of the following areas: Overpayment Recovery, Pre- and Post-pay COB, Subrogation, Premium Enhancement (such as ESRD and Medicare Secondary Payer) and Pre-pay Editing for correct coding and medical payment polices. Many of these activities include oversight of vendors that are supplemental to internal processes and activities.
• Provides leadership to team members and responsible for assigning projects and activities involving inventory management, informational reporting, database configuration, procedures and workflows to ensure quality control and timely turnaround.
• Responsible for facilitating meetings with health plans and vendors for ideation and approval of Payment Integrity initiatives.
• Provides assessments and business rules to Corporate Configuration for COB tables and Claims edits logic in the QNXT system as well as maintenance to the internal Payment Integrity Tracking databases.
• Ensures CMS and state regulatory requirements are met, for Pre-pay Edits, Overpayment Recovery, COB and Subrogation, which improves encounter submissions, reduces G&A costs, and continues to drive positive operational and financial outcomes for all solutions..
  
  

Job Qualifications

Required Education

Bachelor Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Bachelor Degree or equivalent combination of education and experience

Preferred Experience

10 years

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.

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

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