ApplyBlast uses AI to match you with the right jobs, tailor your resume and cover letter, and apply automatically so you can land your dream job faster.

Features

Auto Apply Resume Optimizer Cover Letter Optimizer Interview Prep

Company

Social Media

Need Help?

team@applyblast.com

Clinical Validation Payment Integrity Review Operations Manager at Molina Healthcare - ApplyBlast

Clinical Validation Payment Integrity Review Operations Manager

Molina Healthcare

1 month ago

United States

Onsite

Full Time

Manager

0 applicants

View Job Listing

Apply to 100+ jobs

About this role

This role manages clinical validation payment integrity review operations, overseeing DRG validation, itemized bill review, and revenue code accuracy to ensure timely and defensible claim outcomes. The position involves leading team performance, resolving escalated cases, and collaborating with cross-functional stakeholders to improve workflow and payment accuracy. It requires a registered nurse with coding certification and extensive experience in healthcare audit operations.

Responsibilities

Manage clinical validation payment integrity review operations and DRG validation programs
Oversee workflow, inventory, and review quality to ensure accurate and defensible outcomes
Resolve escalated cases and collaborate with cross-functional teams to improve payment accuracy

Skills

Qualifications

Registered Nurse (RN)Certified Coding Specialist (CCS)Certified Inpatient Coder (CIC)Registered Health Information Technician (RHIT)Registered Health Information Administrator (RHIA)