Molina Medicaid Solutions - DHHR

Bridging the Rivers ofChange TogetherWest Virginia MMIS Re-ProcurementSolicitation: MED13006ROLE RESPONSIBILITIES SKILL SETand/or customersupport and enable less experienced staff Displays excellent time management whenhandling special projects that include butare not limited to member mail, LTC calls,nursing home, hospice, and researchProvider/MemberInquiry LeadProvider/MemberInquiryManagerDirects the assigned department on policyand procedures related to callcenter/correspondence/field inquiriesSupervises the team including recruitment,development and motivation of staffFacilitates meetings with the teams todiscuss issues/suggestions forimprovement and assists the manager withthe implementation of changesResolves problems to ensure complianceand customer satisfactionBuilds trust and strong businessrelationships internally and externallyResearches, reports and analyzes callcenter/correspondence/field data andcreates reports for results, monitoring andrecommendationsWorks collaboratively with all monitoringfunctions to assure accuracy and quality ofinformationDirects the assigned department on policyand procedures related to claims/providers/membersManages a team of representatives thatincludes recruitment, development, andmanagement of staffInitiates and communicates a variety ofpersonnel actions that includesemployment, termination, and performancereviewsPerforms salary reviews and disciplinaryactionsFacilitates meetings with the customer/client and the necessary management teamto discuss provider/member issues; offerssuggestions for improvement and/orchanges; assists with the implementation ofchangesAssists providers and members withproblem solving and resolution of moreBachelors degree or equivalent experienceThree to five years of leadership/supervisory experience in a call centeroperations environmentFour plus years of experience in claimsand/or benefits interpretation and providernetworkingSubstantive knowledge of health carepolicy and directionGood knowledge and understanding ofMedicaid policies and proceduresGood working knowledge of the Medicaidpolicies, medical billing, authorizationprocesses, and enrollmentAbility to build positive and collaborativerelationshipsLeadership qualitiesAbility to multi-task in a high pacedenvironmentExcellent verbal and writtencommunication skillsExcellent customer service skillsExcellent organizational and analyticalskillsBachelor’s Degree or equivalentexperienceFive or more years of supervisoryexperience in a call center operationsenvironmentFour or more years experience in claimsand/or benefits interpretation and providernetworkingSubstantive knowledge of health carepolicy and directionStrong analytic and problem solvingabilitiesThrough direct interactions with providers,builds positive and collaborativerelationshipsLeadership qualitiesAbility to multi task in a high pacedenvironmentExcellent verbal and written14.4-34