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Supervisor, Provider Inquiry Research & Resolution


Molina Healthcare Inc.

is among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare-including individuals covered under Medicaid, and Medicare, the Healthy Families Program, the State Children's Health Insurance Program (SCHIP) and other government-sponsored health insurance programs.

Currently we provide healthcare assistance to approximately 1.4 million members in sixteen (16) states.

Molina has health plans in California, Indiana, Michigan, New Mexico, Ohio, Texas, Utah, Washington, Florida, Louisiana, Idaho, Maine, New Jersey, West Virginia, Virginia, Wisconsin and as well as 19 primary care clinics located in Northern and Southern California.

The company's corporate headquarters are in Long Beach, California.
Molina Healthcare, Inc.

has an immediate opening for a Supervisor, Provider Inquiry Research & Resolution for Houston, TX.
Molina Healthcare is a publicly traded Fortune 1000 company with approximately 4,500 employees and revenues of $3.6 billion.

Position Summary
This position is responsible for all Provider Inquiry Resolution for the Plan.

Under the direct supervision of [Director or VP of Network Management & Operations] the Supervisor is responsible for the submission/resolution of Provider Inquiries and/or Dispute Resolutions.

The job includes proactive assessment and audit of business processes to determine those most effective to efficiently and effectively resolve Provider Problems.

The Supervisor ensures documentation and reports are completed according to regulations.

Serves as primary interface with Corporate counterparts and ensures standard processes are implemented.

Maintains confidentiality as required.
Knowledge, Skills and Abilities
* Must know computerized claims processing systems
* Data entry and 10-key skills by touch and sight
* Knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
* Comprehensive medical terminology and knowledge
* Efficiency and accuracy of claim payments during processing and adjudication.

Analytical ability
* Excellent verbal and written communication skills
* Ability to abide by Molina’s policies
* Maintain regular attendance based on agreed-upon schedule
* 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
Required Education
* High School diploma
* 2 year degree or 4+ years of work experience in field
Preferred Education
* Bachelor’s Degree
Required Experience
* 4 Years experience in claims review and Provider and Member dispute resolution
* Excellent vocabulary, grammar, spelling, punctuation, and composition skills proven through the development of written communication.

Comprehensive knowledge of health care customer service,...

 


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