2024-04-22
Molina Healthcare (https://careers.molinahealthcare.com/)
Other
/yr
full-time
employee
Albuquerque
New Mexico
United States
Molina Healthcare is hiring in New Mexico for several Billing & Claims, Tribal Liaisons.
These roles are specifically responsible for working with tribal entities regarding billing and claims support and resolution activities.
Highly qualified candidates will have strong communication skills, excellent Microsoft Office product knowledge, and experience with Native American provider relationship management.
These roles are remote, candidate must reside in New Mexico, as there may need to travel within the state according to business needs.
Strong claims knowledge and IHS is required.
Job Summary
Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.
Knowledge/Skills/Abilities
Assists Molina Healthcare in promoting Native American's access to healthcare coverage and educates communities about the general and value added services provided by Molina Healthcare. Responsible for building and maintaining relationships with tribal community leaders, community-based organizations and providers within tribal lands and reservations through a combination of direct and indirect outreach and engagement activities directed toward building enrollment for all Health Plan lines of business. Establishes formal working relationships with and acts as a central point of contact to the Indian Health Services (IHS) facilities and tribal 638 facilities. Interacts with other Molina Healthcare departments to improve services provided to Native American members, prospective members, IHS and tribal 638 providers. As requested, helps support Molina Healthcare's relationship with IHS and tribal 638 facilities and establishes relationships with tribal employers.
Job Qualifications
Required Education: High School Diploma or GED
Preferred Education: Bachelor's Degree preferred
Required Experience:
3-5 years experience in healthcare industry, preferably in the Medicaid Managed Care Programs
Previous healthcare marketing and/or grassroots/community outreach experience
Preferred Experience:
Experience in the Medicaid Managed Care Programs
Experience with behavioral health and/or coordination of Long-Term Services preferred
Required License, Certification, Association:
Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
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.
Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor,
#PJHPO
#LI-AC1
Pay Range: $40,851.44 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.