Molina Healthcare
Program Manager, Health Plan Payment Integrity (REMOTE - Connecticut Based Candidate Preferred)
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Job Description
- Req#: 2035508
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive benefits and compensation package
- Work remotely while residing in Connecticut
- Collaborative and supportive work environment
- Chance to influence health plan strategy and contribute to regulatory compliance
What to Expect (Job Responsibilities):
- Manage and execute scorable action items (SAIs) to ensure compliance with CMS and state regulatory requirements for payment integrity
- Lead initiatives to improve claim payment accuracy and financial performance
- Collaborate with operational teams and stakeholders to proactively identify issues and implement solutions
- Provide strategic recommendations to health plan leadership that align with business goals
- Utilize data analysis tools to support business analysis and facilitate decision-making
What is Required (Qualifications):
- Minimum of 5 years of business analyst experience in a managed care organization, with at least 3 years in Medicaid and/or Medicare programs
- Proven experience managing operational projects related to provider reimbursement and claims payment integrity
- Strong knowledge of managed care claims coding and federal/state Medicaid payment rules
- Proficient in data analysis and ability to derive insights for business decisions
- Excellent written and verbal communication skills, with the ability to synthesize complex information
How to Stand Out (Preferred Qualifications):
- Experience with Medicare, Medicaid, and/or Marketplace lines of business
- Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification
- Project management experience
- Familiarity with Medicaid-specific scorable action items and payment integrity programs
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Molina Healthcare is a managed care company headquartered in Long Beach, California, United States.
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