Director, Revenue Management (Revenue Accuracy/Risk Adjustment)- REMOTE

Job Description

Job Summary
Use of general CMS risk adjustment methodologies and rules to create reports and analysis. Duties include all aspects of review of the revenue completeness and accuracy, such as, review of claims data, analysis of financial data, preparation of analyses, forecasts, financial statements and reports, and auditing responsibilities.

Knowledge/Skills/Abilities
• Reconciles Center for Medicare (CMS) monthly revenue lines for Part C & D. Revises monthly discrepancies and coordinates with corresponding departments to process findings to ensure accuracy of Medicare, Medicaid, and Marketplace revenue.

• Provides subject matter expertise and visible operational initiatives to ensure revenue completeness and accuracy. Coordinates with Encounters, Compliance, Pharmacy, in all processes identified for revenue accuracy.
  • Monitors data flow and quality with all department involved, pharmacy, IT, Encounters, Compliance. Verifies submission requirements and related timeline.
  • Creates and manages reporting, including dashboard summaries to corresponding corporate and state plans departments.
  • Provides corresponding analysis, support strategic planning, and forecasting for all Molina Healthcare lines of business.

Job Qualifications

Required Education
Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Experience

10+ years' experience.

Managed Care industry experience.

Expertise with Power BI, Tableau, and SAS.

Risk Adjustment knowledge; CMS Risk Adjustment methodology.

Claims data analysis experience.

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.