Job Details

Job Summary

The Assistant Vice President of Encounters Management plays a critical role in shaping the overarching strategy and governance for tracking, evaluating, and submitting encounter deletions across Medicare Advantage, ACA, and Medicaid lines of business. This pivotal position is accountable for ensuring compliance with intricate regulatory standards, safeguarding the integrity of enterprise revenue, and supporting the overall risk adjustment strategy of the organization.

Key Responsibilities

• Oversee the accuracy and completeness of encounter submissions, including production, audits, and vendor oversight, while working to increase the volume and quality of encounter data received from providers.
• Manage encounter submissions, including rejection management and resolution for all lines of business, collaborating with strategic partners in the healthcare sector to decrease overall costs.
• Utilize strong influencing skills across various departments including Payment Integrity, Claims, and Finance to drive improvements and decisions.
• Lead complex projects focused on improving enterprise-wide processes, spanning claims, encounters, clinical operations, finance, and analytics.
• Identify training opportunities for staff and implement standardized processes that enhance the overall management and processing accuracy of encounters.
• Monitor compliance with encounter submission timelines to mitigate any potential penalties.
• Drive initiatives to reduce operational costs and identify opportunities for accurate encounter management, directly impacting risk revenue and compliance quality.
• Collaborate with the Corporate Operational Leadership Team to analyze data variations and propose enhancements in processes.
• Work closely with leadership and peers to set improvement objectives and execute strategic goals in the operational plan.
• Manage both direct staff and vendors, ensuring that operational results are achieved efficiently, consistently, and in compliance with standards.
• Ensure adherence to state, federal, and Molina regulations and policies to maintain the highest compliance within the Encounters Department.
• Assist in budget management and seek ways to enhance productivity and automation to lower overall costs.
• Implement strategies to improve member and encounter first-pass rates to boost operational efficiencies.

Qualifications

• 8+ years of healthcare or operational experience in a related field.
• A minimum of 2 years in a Director-level role or higher.
• Thorough understanding of Medicare Advantage, ACA, and Medicaid risk adjustment processes.
• Experience managing budgets across multiple markets or product lines.
• Skilled in account and vendor management.
• Excellent verbal and written communication skills, with an ability to influence change within the organization.
• Adept at proposing and implementing future state processes that align with the organization's strategic direction.

Education Requirement

• Bachelor's Degree or equivalent experience.

To apply for this position, please ensure you submit your application through the intranet job listing.

Molina Healthcare offers a competitive compensation and benefits package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $122,430.44 - $238,739.35 / ANNUAL.

*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.