- Molina Healthcare (Owensboro, KY)
- …This role focuses on identifying and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will ... lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. +...6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization… more
- Molina Healthcare (Owensboro, KY)
- …workflows and controls across intake, adjudication, adjustments, appeals/grievances, and payment integrity . + Technology Enablement: Oversee requirements, ... (Healthcare/Claims)** + Deep understanding of claims lifecycle, EDI transactions, payment integrity , provider data, appeals/grievances, and audit/compliance… more
- Molina Healthcare (Owensboro, KY)
- …level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to ... + Supplies criteria supporting all recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs,… more