Program Manager (Ohio Claims Processes)

Molina Healthcare•Long Beach, CA

14h

About The Position

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.

Requirements

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.

Nice To Haves

Diverse practical experience in Ohio Medicaid Claims Adjudication and Payment Policy.
Experienced in claims adjudication of Medicare and Marketplace (ACA) claims.
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).

Responsibilities

Ensuring well-documented policies, workflows, program controls, internal and third-party practices, playbooks and best practices for respective program.
Managing program budget, as applicable, supporting project prioritization.
Collaborating with Legal, Compliance, and Information Security to ensure governance standards are upheld.
Tracking performance metrics and ensuring value realization from deployed solutions.
Coordinating recurring meetings to support governance framework and decision-making processes, as needed.
Supporting portfolio management and/or initiative-specific change and project management at the direction of program leadership.
Collaborating with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral.
Routinely reviewing program collateral to ensure current and accurate reflection of business needs.
Identifying opportunities/gaps and providing recommendations on program enhancements to respective leadership team.
Creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
Generating and distributing standard reports on schedule.