Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006ROLE RESPONSIBILITIES SKILL SETsuggestions for improvement and/orchanges; assists with the implementationHealth Insurance Portability andAccountability Act (HIPAA)of changesMedical/Dental QualityManagerFinancialManagerAssists providers with problem solving andresolution of more complex claims andother issues; advises providers of newprotocols, policies and proceduresProactively resolves problems to ensurecompliance with contract terms andresolve problems due to system issuesResearches and coordinates the resolutionof provider claimsResearches and analyzes call center dataand create reports for results andrecommendationsWorks collaboratively with the qualityimprovement department to review theaccuracy, completeness, and verification ofprovider/member callsOversees all QA functions, includingdeliverable review, accuracy of reports,system enhancement documentation, andreview of test resultsCommunicates with providers on an asneededbasisManages the onsite financial operationsteam; responsible for the day-to-dayactivities of the financial accountingsystemHandles all accounts payables and accountreceivables as well as works with andprovides analysis for the Flexi financialsystemEnsures that all financial transactions areproperly administered and monitored,including accounts payable, accountsreceivable as well as weekly, monthly,quarterly and annual financial reports thatsupport the MMISProvides analytical support and analysis ofthe financial system surroundingadjudication and payment processingOversees the day-to-day financialadjustment team including personnel andrelated claim and the Flexi financialsystem processesAbility to establish and maintain positiveand effective work relationships withcoworkers, clients, members, providersand customersBachelor degree or four years of directlyrelevant experienceFour years experience as a quality managerfor a state Medicaid agency or fiscal agentExperience in development andmaintenance of a vigorous ongoing qualitycontrol function encompassing data entry,job balancing, system output, data integrityvalidation, system control, accountingProvider communication skillsBachelor’s degree in accounting, businessadministration or economics or equivalentexperienceFive years experience managing anorganizational department or unitresponsible for the accounting, budgetand/or reporting function of a largecommercial healthcare claims processingorganization, Medicaid agency, or asimilar government projectPreferred MMIS financial managementand accounting experienceKnowledge of implementing financialclaims adjustments and monitoring theprocessesMore than one year SQL Server processingand coding14.4-5