Claims Data Coordinator

ABOUT US: Molina Healthcare of Michigan is one of Michigan’s fastest growing Medicaid health plans. Molina serves over 144,000 Members in 38 Lower Peninsula counties including Kent, Wayne, Oakland and Macomb and relies on community physicians, local rural health clinics and hospitals for its provider network throughout Michigan. This combination of urban and rural service areas makes Molina a unique Medicaid Health Plan.

Molina Healthcare of Michigan is committed to clinical excellence and quality improvement through its healthcare initiatives for childhood immunizations--including preventive healthcare for children and adults, and chronic disease management.


Department: Provider/Claims Services

Job Description:
Maintain the workflow processes associated with the Provider Service Issue mailbox and update the QMACS system for all par providers.

Maintain log for incorrect payments received by providers.

Consistently ensure system data accuracy and completion of processes for non-participating providers.

Coordinates the par PIF process.

Liaison for external Provider Services Representatives.

Job Requirements


Required:
High School diploma or equivalent

1-plus years experience in Managed Care

2-plus years experience in claims processing

Knowledge of various payment methodologies

Experience and knowledge of State of MI Medicaid Regulations.

Medical terminology

Interpersonal Communication Skills

Excellent Verbal and Written communication skills

Excellent organization skills

Excellent Problem Solving and Analytical Ability

Preferred:
Associates in Health Care related field or related discipline.

Previous Medicaid Experience