Clipped from:

Under the general direction the SVP, Integration & Innovations is responsible for the strategy, design, and management of the team that will implement companywide initiatives impacting:
Encounters Accuracy & Completeness (ie Encounter Production, Audit, Production Vendor Oversight) for all lines of business.
Responsible for centralizing all corec encounter submission processes including identification of any vendor or system support requirement for most effective and accurate processing. Assessment of resources across the organization for purposes of centralization and establishing an Encounters Center of Excellence
Assume all (Encounter) submissions currently sitting in Risk Adjustment to ensure standardization, completeness and accuracy of submissions
Develop and implement all montoring reporting needed for optimized outcomes and reduce/eliminate financial penalties.
Responsible for increasing volume of encounters received from providers, improve completeness of encounter data with states, CMS, HHS to reconcile data.
Implemented processes to monitor rejected encounters to correct and resubmit where applicable
Improve submission accuracy for frequent occurring error codes and create systemic imporvements
Standardize State/LOB reporting increasing visibility into accuracy & completeness
Centralize and automate standardized resources, requirements and encounter tranformation
Encounter submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters including but not limited to the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, Enrollment and Billing, Encounters Team as well as providing overall organizational leadership aimed at managing overall healthcare costs.
Hires, coordinates training and manages staff involved in creating controls, documents and tools within the Encounter process in order to manage work in any of the assigned resources.
Identifies, develops and trains appropriate staff and implements processes to standardize the overall ends-to-end processing, management and accuracy of encounters, as well as working with partner departments to implement process improvements impacting quality and timeliness of encounters processing and accuracy.
Ongoing monitoring and management rhgouth resolution any potential penalities related to accuracy and timliness of encounters submissions.
Initiates staff and coordinates needed projects around various systems enhancements, conversions and upgrades. These projects improve QNXT Claims MASS Adjudication results, enhances the Corporate Operations claims quality and reduces unit claims costs by reducing rework (both underpayments and overpayments) for all lines of business.
Identifies projects/initiatives that reduce administrative costs for Molina and/or providers as well as identifies opportunities to ensure accurate encounters are occurring to assist in the management of the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Convenes work groups, develops implementation plans with identified tasks, timelines and assigned parties. Executes and measures success.
Participates with others in the Corporate Operational Leadership Team along with IT to analyze the root cause of information of variations to the encounters, to find/propose ways to improve
upon performance results, to identify potential risks to the organization and to lead the needed changes within the encounters process to support the organizational needs in all lines of business.
Collaborate with leadership, peers, and business partners to establish encounters improvement objectives and execute business priorities based on strategic goals in the operational plan.
Works with the Training Team in preparing needed documentation around training of new/existing staff while also assisting in preparing needed Guidelines to assist in the timely and accurate processing of encounters for all lines of business.
Manages direct Molina staff as well as oversees vendors involved in any of the areas reporting to the VP, Core Operations – Encounters to enable the organization to produce operational results at the lowest possible cost, the most consistent and compliant service levels and the highest level of quality for all lines of business.
Ensures all state, federal and Molina regulations, Policies/Procedures and SOPs are implemented and followed on a consistent basis to ensure the highest compliance possible within the Corporate Operations areas.
Sets and manages overall costs to meet/exceed annual budgets and finds ways to improve productivity and automation wherever possible to reduce unit costs and overall G&A for the organization.
Design and implement systematic approach to improve member and provider experiences through increased operational efficiency and effectiveness.
Responsible for reporting potential liabilities for financial tracking and accruals to senior leadership.
Excellent verbal and written communication skills.
Ability to influence and drive change among peers and others within the Molina organization.
Skill to envision, craft proposals, obtain consensus around approving and implementing future state processes and systems needed to support strategic direction set by organization.
Ability to abide by Molinas policies.
Ability to maintain attendance to support required quality and quantity of work.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Other duties as assigned.