- Molina Healthcare (Dayton, OH)
- …provider contract, network development and management, or project management experience in a managed healthcare setting. **Required Experience** + 2 - 3 years ... in a managed care setting. + Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare… more
- Highmark Health (Columbus, OH)
- …healthcare operations, risk, audit, or legal functions + 5 years in Healthcare Compliance or Privacy **LICENSES or CERTIFICATIONS** **Required** + None ... rules as well as a solid working knowledge of managed care operations, compliance program structures, information...(CIA) + Certified Fraud Examiner (CFE) + Certified in Healthcare Compliance (CHC) + Certified Compliance… more
- Molina Healthcare (Akron, OH)
- …network development and management, or project management experience in a managed healthcare setting. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : ... in a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare… more
- Molina Healthcare (Columbus, OH)
- …Participate in process improvement initiatives to improve operations + Understands the compliance and regulatory guidelines for each state + Maintains ... coaching, production and appropriate terminations. + Ensures staff is compliant with regulatory and company guidelines, including HIPAA compliance . + Responsible… more
- Molina Healthcare (Cincinnati, OH)
- …in resolving complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional ... trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
- Molina Healthcare (Akron, OH)
- …in resolving complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional ... trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
- Molina Healthcare (Cleveland, OH)
- …or utilization management experience. + 3+ years supervisory experience in a managed healthcare environment. + Previous experience in Hospital Acute Care, ... non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards. + Manages… more
- Molina Healthcare (OH)
- …contracts activities including maintenance of state correspondence and regulatory databases, communication of deliverables/submission between staff and governmental ... agencies and contract review. * Maintains calendar and databases documenting regulatory filings, approvals of member materials, member/provider inquires and ad hoc … more
- Molina Healthcare (OH)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (Akron, OH)
- …the Delegation Oversight Department. Oversees delegated activities to ensure compliance requirements including delegation standards and requirements contained in the ... Molina Medical Compliance and Fraud, Waste and Abuse Program. **KNOWLEDGE/SKILLS/ABILITIES** +...of education and experience. **Required Experience** + 3+ years managed care experience. + Min. 1 year experience completing… more