Job Description

　　Job Summary

　　The Mgr, Encounters leads a team supporting encounters operations and/or encounters optimization for multiple markets or states, and is accountable for timely, accurate, and complete encounter submissions. Identifies and leads encounter operations improvements and partners with cross-functional teams to remediate and resolve root causes of issues impacting encounters.

　　Job Duties

　　Accountable for achieving performance and compliance metrics for encounters such as timeliness, accruacy, and completeness of submissions

　　Monitors and/or assigns encounters workflow and inventory, and ensures volume and aging are current

　　Mentors and trains encounters team members

　　Serves as thought leader and engages in shaping future state of operational processes and solutions

　　Ensures appropriate end-to-end controls and monitoring of encounters and drives implementation of process improvements

　　Defines and maintains operational policies and procedures related to encounters operations

　　Leverages subject matter expertise to support resolution and escalate encounter rejections and other submission issues

　　Leads root cause resolution of systemic encounter errors

　　Facilitates monthly governance calls with market or state health plan leaders and other stakeholders

　　Communicates effectively to translate complex encounter concepts so they can understood by a variety of audiences

　　Oversees research, analysis, and drives resolution of encounter issues related to upstream claims, members, providers, vendors, inbound and outbound processes

　　Monitors vendor encounter submissions, contractual compliance, and SLAs

　　Works closely with other departments to align claims intake edits, encounter edits, and regulator edits

　　Monitors and/or oversees projects across all teams/departments to address corrections, changes, and updates to ensure encounter submissions compliance and acceptance

　　Works with various levels of leadership across the organization with respect to encounter status, reporting, and impacts, and coordinates with Government Relations and Health Plan leadership to ensure accurate and timely distribution of information pertaining to encounters operations, submission status, timeliness, and accuracy.

　　Job Qualifications

　　REQUIRED EDUCATION :

　　Bachelor’s Degree or equivalent experience

　　REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

　　8 years or more of managed care experience

　　Previous experience leading operational teams

　　Strong interpersonal and people leader skills, encounters subject matter expertise, and solid grasp of technical solutions

　　Proficient with verbal and written presentation of complex operational information

　　PREFERRED EXPERIENCE :

　　Claims processing, provider contacting, health data analysis and reporting, project management, working with various levels of management throughout multiple organizations

　　PREFERRED LICENSE, CERTIFICATION, ASSOCIATION :

　　Certified Professional Coder (CPC)

　　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.

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　　Pay Range: $72,370.82 - $156,803.45 / ANNUAL

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