Teams at Molina Healthcare Inc.

Senior executive responsible for strategy and leadership of provider network operations and contracting. Oversees contract negotiations (APMs, VBP, capitation), reimbursement strategy, contract management, provider relations, delegation oversight, network adequacy, team leadership, and cross-functional collaboration to drive financial and operational performance.

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.