Lead, Core Operations

Molina Healthcare•Long Beach, CA

5d•Onsite

About The Position

Molina Healthcare Services (HCS) is required by CMS and state agencies to coordinate benefits when other carriers are responsible for payment. This requires the maintenance of other insurance records and has a direct impact on medical expenses and premium reimbursement.

Requirements

Associate's degree or equivalent experience
3 years' experience in a billing, claims review or processing.
3 years' experience in managed care or health care industry.

Responsibilities

Monitors and controls backlog and workflow of claims.
With Supervisor and Manager, coordinates workflow and staffing of day-to-day activities as well as assigns and monitors work of staff in order to adhere to productivity and quality standards.
Perform daily troubleshooting procedures to support team functions as needed.
Participates in or leads quality improvement efforts to improve claims processes and/or policies.
Implement processes to increase productivity and efficiency.
Serve as subject matter expert and provide feedback to team personnel and provide training as needed.
Phones or utilizes other insurance company portals to validate state, vendor and internal COB leads.
Review, validate and make updates to the other insurance table on the claims transactional system and COB tracking database.