Provides analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules as they apply to each database, validating data to be housed on databases, and ensuing adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
Essential Job Duties
• Analyzes and interprets data to determine appropriate configuration changes.
• Accurately interprets specific state and/or federal benefits, in addition to other business requirements, and converts terms to configuration parameters.
• Manages coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables in the user interface.
• Applies experience and knowledge to research and resolve claim/encounter issues and pended claims, and updates system(s) as necessary.
• Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community.
Required Qualifications
• At least 2 years of configuration information management experience maintaining databases, and/or analyst experience working within a health care operations setting, or equivalent combination of relevant education and experience.
• Experience using a claims processing system.
• Experience verifying documentation related to updates/changes within a claims processing system.
• Experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements.
• Analytical and critical-thinking skills.
• Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery
• Attention to detail.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency, including Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.
Preferred Qualifications
• Experience in a managed care organization supporting Medicaid, Medicare and/or Marketplace programs.
• Intermediate to advanced Microsoft Excel skills.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Skills Required
- At least 2 years of configuration information management or analyst experience in a health care operations setting (or equivalent education/experience).
- Experience using a claims processing system.
- Experience verifying documentation related to updates/changes within a claims processing system.
- Experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements.
- Analytical and critical-thinking skills.
- Flexibility to meet changing business requirements and commitment to high-quality/on-time delivery.
- Attention to detail.
- Effective verbal and written communication skills.
- Microsoft Office suite proficiency, including Excel (VLOOKUP, Pivot Tables) and applicable software programs.
- Experience in a managed care organization supporting Medicaid, Medicare and/or Marketplace programs.
- Intermediate to advanced Microsoft Excel skills.
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
