JOB DESCRIPTION
Job Summary
Leads and manages team responsible for provider data management (PDM) activities including analyzing business processes related to PDM, identifying areas for improvement, and developing and implementing solutions to optimize performance. Ensures accurate and timely maintenance of critical provider information for all claims/provider databases, and application of business rules as it pertains to contracting, network management and credentialing.
Essential Job Duties
• Establishes and maintains internal standard operating procedures (SOPs), and enterprise-wide policies and procedures pertaining to provider functions - ensuring alignment with business objectives.
• Champion a culture of continuous improvement by leveraging automation, artificial intelligence, and emerging technologies to optimize processes and deliver measurable business value.
• Collaborates cross-functionally with departments on issues related to provider data management (PDM) including but not limited to: configuration, business systems, encounters (inbound and outbound), claims, provider services and contracting.
• Assists in design and development of new programs as related to transitions and implementations of existing plans with regards to provider data.
• Responds to legislative and regulatory developments and audits as it relates to provider information; collaborates cross-functionally to interface with regulators to develop and implement appropriate corrective action plans (CAPs) for submission of provider network files, etc.
• Demonstrates expertise in the handling and management of complaints and other escalated issues from internal customers.
Required Qualifications
• At least 7 years of experience in provider data management (PDM), including business analytics experience in health care, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Advanced proficiency in data analysis tools and techniques.
• Strong presentation and interpersonal skills, and ability to interact effectively with stakeholders at all levels.
• Strong critical-thinking skills, and attention to detail.
• Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
• Strong verbal and written communication skills.
• Microsoft Office suite (including advanced Excel) and applicable software program(s) proficiency.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Skills Required
- At least 7 years of experience in provider data management (PDM), including business analytics experience in health care, or equivalent combination of relevant education and experience.
- At least 1 year management/leadership experience.
- Advanced proficiency in data analysis tools and techniques.
- Strong presentation and interpersonal skills, and ability to interact effectively with stakeholders at all levels.
- Strong critical-thinking skills, and attention to detail.
- Strong organizational and time-management skills; ability to manage simultaneous projects and tasks to meet internal deadlines.
- Strong verbal and written communication skills.
- Microsoft Office suite (including advanced Excel) and applicable software program(s) proficiency.
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
.png)
