Remote Program Manager, Health Plan Claims & Recovery

Molina Healthcare, Inc.; Kentucky; À distance; USD 69 000 - 135 000; Plein temps

Avantages offerts par ce poste

Competitive benefits

Résumé du poste

Molina Healthcare of Kentucky is hiring a Program Manager, Health Plan Payment Integrity (Claims & Recovery). This position is remote, offering leadership in PI initiatives and regulatory compliance across CMS and state requirements.

The role drives the execution of SAIs, supports data-driven decision making, and collaborates with cross-functional teams to improve encounter submissions and cost containment for Kentucky Medicaid/Medicare programs.

Qualifications

• 5+ years of business analyst experience in a managed care organization.

Responsabilités

• Provides subject matter expertise for oversight, production, and resolution of health plan payment integrity (PI) recovery concepts.

Connaissances

Managed care experience

Medicaid/Medicare experience

Claims processing knowledge

Payment integrity

CPT/HCPCS/ICD knowledge

Revenue codes

Analytical skills

Communication skills

Outils

CPT coding

HCPCS coding

ICD coding

Revenue codes

Description du poste

Molina Healthcare of Kentucky is hiring a Program Manager, Health Plan Payment Integrity (Claims & Recovery). This position is remote, offering leadership in PI initiatives and regulatory compliance across CMS and state requirements.

The role drives the execution of SAIs, supports data-driven decision making, and collaborates with cross-functional teams to improve encounter submissions and cost containment for Kentucky Medicaid/Medicare programs.