Manager, Configuration - Product Owner/Custom Solutions - Remote

Molina Healthcare is a leading organization in the healthcare sector, and they are seeking a Manager for their Configuration team. The role involves leading the team responsible for configuration activities, ensuring compliance with health plan requirements, and managing audits and operational policies.

Responsibilities:

• Manages configuration team, and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements
• Represents as primary liaison with various functional areas/stakeholders (i.e. utilization management, claims, configuration, provider network, health plan leadership, etc.) to seek understanding of workflows and obtain required documentation for applicable audits
• Leads and organizes audit submissions and interacts with auditors as applicable
• 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 to leadership
• Participates in and contributes to the development of configuration related strategies to meet business needs
• Conducts and documents operational meetings with health plans on a monthly basis
• Provides guidance to team regarding interpretation of specific state and/or federal benefits, benefit and provider contracts, in addition to business requirements (i.e. coding, system tables, fee schedules, etc.), and converts terms to configuration parameters
• Develops and coaches direct configuration team - promoting professional growth and development
• Maintains awareness of current laws, regulations, statutes, etc. for assigned area(s) of operations audited by team
• Proactively works with leadership on operational effectiveness to ensure compliance
• Performs analysis and reviews to ensure configuration performance targets are met
• 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 the configuration 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

Requirements:

• At least 7 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
• At least 1 year of management/leadership 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
• Ability 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
• Certified Professional Coder (CPC)
• Experience leading analysis and operational teams in a managed care setting
• Experience collaborating with various levels of leadership in a highly matrixed organization
• Deep claims processing, configuration and queries experience