AVP, Encounters (Remote)

About the Role

Provides strategy and leadership for the team responsible for encounters activities, including monitoring inbound and outbound processes and ensuring timely, accurate, and complete encounter submissions for low to moderate complexity markets or states.

Facilitates data and process analysis, collaborates with cross-functional teams to identify and resolve root causes of issues impacting encounters, and provides recommendations for improvements to enhance operational performance.

Responsibilities

• Supports strategy development, vision, and direction for the encounters function.
• Demonstrates accountability for performance, financial results, and encounters accuracy and completeness (e.g., production, audit, vendor oversight) for assigned lines of business.
• Ensures encounter submissions, rejection management, and resolution for all lines of business, including internal strategic partnerships.
• Actively participates in hiring, coordinates training, and manages staff involved in creating controls, documents, and tools within the encounter process.
• Identifies, develops, and trains direct reporting encounters staff and implements processes to standardize end-to-end processing, management, and accuracy of encounters.
• Facilitates ongoing monitoring and resolution of potential penalties related to accuracy and timeliness of encounter submissions.
• Manages encounters-related operational projects to reduce administrative costs and improve accuracy, supporting organizational healthcare cost management.
• Partners with senior leadership to align business goals and objectives for cost-saving initiatives.
• Convenes encounters-related work groups, develops implementation plans, and executes and measures success.
• Analyzes root causes of variations in encounters, proposes improvements, and leads process changes to support organizational needs.
• Collaborates with leadership and business partners to establish improvement objectives and execute business priorities.
• Manages direct report staff and oversees vendors to achieve operational results at the lowest cost and highest quality.
• Ensures compliance with all state, federal, and Molina regulations, policies, and procedures.
• Assists senior leadership in managing costs to meet annual budgets and improve productivity and automation.
• Identifies and implements systematic approaches to improve member and encounter first-pass rates and operational efficiency.

Qualifications

• At least 10 years of experience in billing, claims, encounters, and/or data analysis, preferably in a senior leadership capacity in a managed care setting.
• At least 5 years of management/leadership experience.
• Expert knowledge of healthcare encounters and advanced knowledge of data analysis techniques.
• Experience writing basic to advanced queries.
• Previous experience with multiple markets or product lines.
• Experience managing a department budget within prescribed parameters.
• Experience with account management and vendor management.
• Ability to present complex operational information and work cross-collaboratively across teams.
• Strong organizational, time management, and interpersonal skills.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office suite and applicable software programs.

Preferred Qualifications

• Strong encounters operations, implementation, reporting, claims processing, provider contacting, health data analysis, and project management experience.
• Experience working with various levels of leadership in a highly matrixed organization.

Pay

Pay Range: $122,430.44 - $238,739.35 per year. Actual compensation may vary based on geographic location, work experience, education, and skill level.