Supervisor, Configuration Oversight (Payment Integrity Claims Audit)

Supervisor, Configuration Oversight (Payment Integrity Claims Audit)

Essential Job Duties

• Supervises and leads team responsible for configuration oversight activities.
• Oversees end-to-end audits, internal operating controls, and processes/practices for operational areas including claims, configuration, provider operations, etc.
• Ensures completion of timely audits and compliance with audit standards.
• Compiles and shares audit outcomes with operations functional areas for review and action, and ensures findings are corrected within appropriate time frames and in accordance with cost control/regulatory standards.
• Represents as primary liaison with various functional areas/stakeholders to seek understanding of workflows and obtain required documentation for applicable audits.
• Demonstrates accountability for identifying regulatory compliance issues within various operations functions areas to validate and mitigate risks, and ensure improvement activities in functional support areas are in progress.
• Develops policies and procedures for end-to-end audit process to ensure consistency/compliance.
• Supports review of operational policies, procedures, guidelines, and job aids to ensure compliance with company and government regulations.
• Identifies risks related to operational oversight processes, provides recommendation for mitigation solutions, and reports accordingly to leadership.
• Participates in and contributes to the development of strategies to meet business needs.
• Conducts and documents operational meetings with business partners on a monthly basis.
• Provides guidance to team regarding interpretation of specific state and/or federal benefits, benefit and provider contracts, and business requirements, and converts terms to configuration parameters.
• Maintains awareness of current laws, regulations, statutes, etc. for assigned area(s) of operations audited by team.
• Proactively collaborates with leadership on operational effectiveness to ensure compliance.
• Performs analysis and reviews to ensure performance targets are met.
• Effectively plans for daily priorities, and responds to new priorities and opportunities assigned by leadership.
• Assists with compiling and submitting daily, weekly and monthly departmental reports to leadership.
• Represents as a technical expert in handling complaints and other escalated issues from internal customers.
• Leads performance improvement activities for configuration oversight function.
• Manages fluctuating volumes of work and prioritizes work to meet deadlines and needs of the configuration department and user community.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of configuration/department-specific goals.

Required Qualifications

• At least 6 years of configuration oversight, claims, auditing, and/or health care operations experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience.
• Advanced understanding of claims processes.
• Advanced ability to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources.
• Strong analytical, critical-thinking, and problem-solving skills.
• Strong multitasking ability, and decision-making skills.
• Flexibility to meet changing business requirements, and strong commitment to high-quality/on-time delivery.
• Able to work cross-collaboratively in a highly matrixed organization.
• High attention to detail.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.

Preferred Qualifications

• Management/leadership experience.

About Us

Molina Healthcare is a nationwide Fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range

$59,810.6 - $129,589.63 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.