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Provider Program ManagerOak Brook, IllinoisJob DescriptionJob SummaryThe Provider Program Manager is part of our innovative Enterprise Risk Adjustment Team at the Health Plan level who provides oversight of network strategies and relationship development activities for assigned providers including but not limited to: individualized planning, training and development of providers to align with Molina's Risk Adjustment and Quality initiatives.Accountable for proactively identifying issues, resolving disputes, and coordinates resolutions, implementing and managing assigned providers activities from start through completion of the program. Providing providers with monthly statuses of their progress and provide opportunities for training on the importance of documenting, closing gaps in care, and billing and submitting a claim. This role supports the strategic direction and organization of corporate initiatives to facilitate achievement of the provider engagement programs.Knowledge/Skills/AbilitiesThis role interacts and supports regulatory agency policy and procedures by acting as a key business partner to the Health Plan Case Management, Provider Engagement Team, and Provider Services departments.The position's essential functions are as follows: Tailor programs for providersa) document processes and changesb) create formal processes for the program (visit already completed for example)c) creates and delivers presentationsd) meets with leadership at the larger group level to discuss progress in form of JOCs or other routine scheduled visits Manage provider relationships and must be proficient in discussing gaps, risk scores, claims etc. Identifies functioning processes and process improvement opportunities and follow up with resolution Build strong relationships with providers to ensure open communication is welcomed and openly received Travel scheduled provider visits or related meetings Reliable and able to work independently Full Risk Adjustment program management role Knowledge in Value Based Contract outreach efforts preferred Knowledge of Visio to diagram processes Some experience working with data Experience with Microsoft Excel, Word, PowerPoint Claims knowledge to validate provider payment Create PowerPoint presentations and deliver to case management and other relevant departments Manage member incentivesQualificationsJob QualificationsRequired EducationAssociates Degree or equivalent experiencesRequired Experience 3-5 years managed care experience, preferably with a national or multi-location organization Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliancy Proven ability to innovate and drive organizational change Excellent presentation and communication skillsPreferred EducationBachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience is preferred.Preferred License, Certification, Association Preferred Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC). Certified Coding Specialist (CCS) is considered.To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Vacancy expired!