Remote Health Plan Payment & Recovery Manager

Molina Healthcare, Inc.; United States; A distancia; USD 69.000 - 135.000; Jornada completa

Descripción de la vacante

Molina Healthcare of Kentucky is hiring a Program Manager, Health Plan Payment Integrity (Claims & Recovery). This remote role requires leading PI initiatives, ensuring CMS and state regulatory compliance, and driving cost containment.

Strong knowledge of Medicaid, Medicare, and marketplace programs is highly valued. You will oversee scorable action items, improve claim payment accuracy, and collaborate with finance, compliance, and network teams to deliver measurable outcomes for health plan

Formación

• At least 5 years of business/analyst experience in managed care.
• 3+ years of Medicaid/Medicare program experience or equivalent.
• Knowledge of CPT/HCPCS/ICD and revenue codes for payer claims.

Responsabilidades

• Provide SME oversight for PI recovery concepts and ensure CMS/state compliance.
• Lead and manage SAIs to meet performance and quality targets in PI solutions.
• Collaborate with PI teams to drive cost-containment and regulatory compliance.
• Drive improvements in claim payment accuracy and financial performance.
• Communicate recovery projects to provider relations and leadership.

Conocimientos

Managed care experience

Medicaid experience

Medicare experience

Claims processing knowledge

CPT/HCPCS/ICD knowledge

Revenue codes understanding

Analytical thinking

Problem solving

Independent work

Cross-functional collaboration

Communication skills

Herramientas

Excel

Data analysis tools

Descripción del empleo

Molina Healthcare of Kentucky is hiring a Program Manager, Health Plan Payment Integrity (Claims & Recovery). This remote role requires leading PI initiatives, ensuring CMS and state regulatory compliance, and driving cost containment.

Strong knowledge of Medicaid, Medicare, and marketplace programs is highly valued. You will oversee scorable action items, improve claim payment accuracy, and collaborate with finance, compliance, and network teams to deliver measurable outcomes for health plan