Program Manager; Ohio Claims Processes

JOB DESCRIPTION

Provides support to Molina functional areas through program management, including policy, workflow and process documentation, management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices, and champion networks, as applicable.

This role focuses specifically on claims processes and collaborates heavily with Claims Operations, Provider Relations, and Payment Integrity to ensure Ohio claims are paid timely and accurately.

• Responsible for ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
• Manages program budget, as applicable, supporting project prioritization.
• Collaborates with Legal, Compliance, and Information Security to ensure governance standards are upheld.
• Tracks performance metrics and ensures value realization from deployed solutions.
• Coordinates recurring meetings to support governance framework and decision-making processes, as needed.
• At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management.
• Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
• Routinely reviews program collateral to ensure current and accurate reflection of business needs.
• Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team.
• Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentation.
• Generates and distributes standard reports on schedule.

• At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience.
• Operational Process Improvement experience.
• Managed Care experience, preferably in a shared service, CoE or matrixed environment.
• Experience with Microsoft Project and Visio.
• Strong presentation and communication skills.

• Diverse practical experience in Ohio Medicaid Claims Adjudication and Payment Policy.
• Experienced in claims adjudication of Medicare and Marketplace (ACA) claims.
• Ideal candidate will be proficient with Excel and use of Pivot tables to organize claims data to understand outcomes and trends.
• Experience working with Enterprise Information Management to develop claims based reports, analysis, and Key Process Indicators (KPIs).

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $66,456 - $129,590 / ANNUAL

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