Assoc Rep, Provider InquiryR&R Job at Molina Healthcare
JOB DESCRIPTION
Job Summary
Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.
Provider Inquiry/Services staff are responsible for the submission, research, and resolution of provider inquiries and/or disputes. They respond with the answer to all incoming inquiries and coordinate with other Molina departments as needed to resolve the issue, as well as to correct the underlying cause, ensuring that resolutions are timely and in compliance with all regulatory requirements.
KNOWLEDGE/SKILLS/ABILITIES
Resolves and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies.
Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider problem areas.
Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
Interfaces with other departments regarding questions about provider configuration or other relevant provider issues.
Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements.
Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals.
Monitors each request to ensure all internal and regulatory timelines are met.
JOB QUALIFICATIONS
Required Education
High School diploma or GED equivalent
Required Experience
1-2 years’ experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience.
Preferred Education
Associate degree in Business and/or completion of a vocational program in Managed Care or some other health care aspect providing a certificate at completion.
Preferred Experience
2-3+ years managed care experience.
Preferred License, Certification, Association
CPC certification
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.
Pay Range: $28,183.93 - $54,958.65 a year*
Please Note :
www.bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
Job Summary
Molina Health Plan Operations jobs are responsible for the development and administration of our State health plan's operational departments, programs and services, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations.
Provider Inquiry/Services staff are responsible for the submission, research, and resolution of provider inquiries and/or disputes. They respond with the answer to all incoming inquiries and coordinate with other Molina departments as needed to resolve the issue, as well as to correct the underlying cause, ensuring that resolutions are timely and in compliance with all regulatory requirements.
KNOWLEDGE/SKILLS/ABILITIES
Resolves and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies.
Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Completes appropriate documentation for tracking/trending data; reviews data to assist with identifying potential provider problem areas.
Uses a variety of references to research and prepare healthcare provider information for loading into the health plan system/database; enters provider demographics, contract affiliation, or other data as needed.
Interfaces with other departments regarding questions about provider configuration or other relevant provider issues.
Composes all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements.
Maintains tracking system of correspondence and outcomes; maintains well-organized, accurate and complete files for all appeals.
Monitors each request to ensure all internal and regulatory timelines are met.
JOB QUALIFICATIONS
Required Education
High School diploma or GED equivalent
Required Experience
1-2 years’ experience in a managed care setting; CPT and ICD-9 coding, data entry, and 10-Key experience.
Preferred Education
Associate degree in Business and/or completion of a vocational program in Managed Care or some other health care aspect providing a certificate at completion.
Preferred Experience
2-3+ years managed care experience.
Preferred License, Certification, Association
CPC certification
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.
Pay Range: $28,183.93 - $54,958.65 a year*
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Please Note :
www.bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.