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Dir, Encounters (REMOTE in Iowa)

Company: Molina Healthcare
Location: Ankeny
Posted on: November 21, 2022

Job Description:

Job Description
Job Summary Under the general direction of the VP of Encounters, is responsible for the strategy, and management of the team that will implement initiatives for Encounters. - Job Duties

  • Encounters Accuracy & Completeness (i.e., Encounter Production, Audit, Production Vendor Oversight) for assigned lines of business. Responsible for increasing volume of encounters received from providers, improve completeness of encounter data with states, CMS, HHS to reconcile data.
  • Encounter submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters as well as provides leadership support at managing overall healthcare costs.
  • Actively participate in hiring process, coordinates training and manages staff involved in creating controls, documents, and tools within the Encounter process to manage work in any of the assigned resources.
  • Identifies, develops, and trains appropriate staff and implements processes to standardize the overall ends-to-end processing, management, and accuracy of encounters, as well as working with partner departments to implement process improvements impacting quality and timeliness of encounters processing and accuracy.
  • Ongoing monitoring and management resolution for any potential penalties related to accuracy and timeliness of encounters submissions.
  • Manage projects/initiatives that reduce administrative costs for Molina and/or providers as well as identifies opportunities to ensure accurate encounters are occurring to assist in the management of the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Partner with leadership to ensure alignment of business goal and objective for cost saving. Convenes work groups, develops implementation plans with identified tasks, timelines and assigned parties. Executes and measures success.
  • Partner with leadership to participate in the Corporate Operational Leadership Team along with IT to analyze the root cause of information of variations to the encounters, to find/propose ways to improve upon performance results, to identify potential risks to the organization and to lead the needed changes within the encounters process to support the organizational needs in all lines of business.
  • Collaborate with leadership, peers, and business partners to establish encounters improvement objectives and execute business priorities based on strategic goals in the operational plan.
  • Manages direct Molina staff as well as oversees vendors involved within your reporting structure to enable the organization to produce operational results at the lowest possible cost, the most consistent and compliant service levels, and the highest level of quality for all lines of business.
  • Ensures all state, federal and Molina regulations, Policies/Procedures and SOPs are implemented and followed on a consistent basis to ensure the highest compliance possible within the Encounters Department.
  • Assists VP Encounter with managing costs to meet/exceed annual budgets and finds ways to improve productivity and automation wherever possible to reduce unit costs and overall G&A for the organization.
  • Identify and implement systematic approach to improve member and encounter first pass rate, increase operational efficiency, and effectiveness. - Job Qualifications REQUIRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience REQUIRED EXPERIENCE: --- 6+ years Healthcare or Operational experience in related job
    --- 4 years minimum in Manager level role or above
    --- Accountability for multiple markets or product lines
    --- Experience with managing department budget within prescribed parameters
    --- Experience with account management and vendor management REQUIRED KNOWLEDGE, SKILLS & ABILITIES: --- Excellent verbal and written communication skills
    --- Ability to influence and drive change among peers and others within the Molina organization
    --- Skill to envision, craft proposals, obtain consensus around approving and implementing future state processes and systems needed to support strategic direction set by organization PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. -Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. - 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: $97,298.55 - $189,732.18 a year* *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. #PJHPO

Keywords: Molina Healthcare, Ankeny , Dir, Encounters (REMOTE in Iowa), Other , Ankeny, Iowa

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