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Lead Analyst, Appeals & Grievances Virtual Hiring Event

Company: Molina Healthcare
Location: Las Vegas
Posted on: November 22, 2021

Job Description:

Job SummaryIn partnership with Management, the Lead Analyst, Appeals & Grievances will be responsible for bridging the gap between departments, driving results across people and systems, and focus on increased communication with internal and external business partners to ensure compliance and operational readiness.KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):

  • Responsible for bridging the gap between operational areas and driving results across people, systems and projects that impact Appeals & Grievances with positive results.
  • Responsible for participating in operational readiness activities which may include attending and facilitating meetings, developing workflows and training materials, and meeting deadlines.
  • Drive performance results through process improvement and quality assurance by identifying gaps and conducting root cause analysis to develop remediation plans, and monitoring performance to meet operational goals.
  • Partner with Leadership to develop and implement Service Level Agreements (SLAs) with operational areas to ensure compliance with State and Regulatory guidelines.
  • Serve as a Subject Matter Expert as it relates to User Acceptance Testing (UAT), Regulatory Audits and Compliance. Take a leadership role in participating in meetings related to audits, systems, and projects.
  • Be a resource for the Department in developing internal communications, reports, templates, workflows, policy and procedures, and other documentation.
  • Establish and maintain appropriate monitoring and oversight of A&G documentation on a weekly, monthly, bi-annual, or annual basis.
  • Promote increased communication that fosters a positive work environment with internal and external business partners or entities.
  • Provide mentorship, guidance, and training to new employees.
  • Any other task as assigned by Management.JOB FUNCTION:In partnership with management, the Lead Analyst, Appeals & Grievances will be responsible for bridging the gap between departments, driving results across people and systems, and focus on increased communication with internal and external business partners to ensure compliance and operational readiness.REQUIRED EDUCATION: High School DiplomaREQUIRED EXPERIENCE:
    • Experience with Regulatory agencies such as CMS, DHCFP, DMHC and NCQA.
    • At least 5 years of Operations experience in a Healthcare settingPREFERRED EDUCATION:
      • Associate's or Bachelor's DegreePREFERRED EXPERIENCE:
        • 3+ years of experience within Operations such as Appeals & Grievances, Customer Care, Enrollment, etc.
        • Leadership experience as a Team Lead or above.
        • Experience conducting UAT for systems within Operations
        • Program or Project management experience.PHYSICAL DEMANDS:Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.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.As part of Molina's response to the COVID-19 pandemic, unless otherwise prohibited by law, new hires with a start date of November 1, 2021 or later will be required to be fully vaccinated.Technical requirementsAfter signing up, you will be sent an email with instructions on how to connect.Please be prepared to join the virtual interview from a quiet place using a desktop or mobile device with a working speaker, microphone, and camera. Check to see if your network connection can support an online session. A plugged in ethernet cable or a strong WiFi network signal will help avoid time delays during your conversation.What to prepare
          • ResumePreferred dress codeBusiness casual (dress pants/skirt, button down/blouse, optional tie)About Molina HealthcareMolina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in California, Florida, Illinois, Michigan, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Washington, Wisconsin and Puerto Rico. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.What is a virtual interview?Virtual interviews help employers connect with job seekers when they are not in the same physical location. Since hiring is a human process, employers would like to talk with you online (chat, video or phone) to see if you meet the requirements for the job.

Keywords: Molina Healthcare, Las Vegas , Lead Analyst, Appeals & Grievances Virtual Hiring Event, Professions , Las Vegas, Nevada

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