Teams at Molina Healthcare Inc.

Leads interpretation of regulatory, contractual, benefit, and claims requirements and translates them into system configuration specifications. Supports governance, implementation, testing, defect resolution, reporting, compliance, and financial-impact analysis across health plans and products. Serves as a configuration subject matter expert, leads cross-functional projects, maintains regulatory information, improves configuration standards, and trains team members in a remote, multi-time-zone environment.

Reviews and resolves provider coding-related claim denials by examining medical records, claims, denial reasons, and billing guidelines. Conducts audits, determines whether to uphold or overturn denials, communicates decisions to providers, identifies coding errors, documents findings, and collaborates across departments to support compliance and process improvements.

Leads enterprise architecture strategy, roadmaps, standards, systems integration, cloud implementations, and complex IT transformation initiatives. Provides technical leadership for enterprise rollouts, mergers and acquisitions, cross-functional programs, and scalable technology solutions. Translates business requirements into architectures, evaluates technology trends, improves processes, briefs executives, and mentors architecture teams. Requires extensive enterprise architecture, systems integration, cloud, data analysis, healthcare payer, project management, and stakeholder leadership experience.