JOB DESCRIPTION Job Summary
Provides lead level 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.
• Loads and maintains contracts, benefit and/or reference table information into the claims payment system and other applicable systems.
• Participates in defect resolution for assigned component(s).
• Participates in the implementation and conversion of new and existing health plans.
• Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.
• Assists with development of configuration standards and best practices, and suggests improvement processes to ensure systems are working efficiently and enhance quality.
• Creates reporting tools to enhance communication on configuration updates and initiatives.
• Negotiates expected configuration information management completion dates with health plans.
• Collaborates with internal and external stakeholders to understand business objectives and processes.
• Solutions with health plans and corporate functions to ensure all end-to-end business requirements have been documented.
• Assists leadership in establishing standards, guidelines, and best practices for the configuration information management team.
• Represents as a departmental configuration information management subject matter expert.
• Supports various department-wide configuration information management projects.
• Provides training and support to new and existing configuration information management team members, including configuration functionality, enhancements and updates
• Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community.
Required Qualifications
- At least 5 years of configuration information management experience maintaining databases, and/or analyst experience within a health care operations setting in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience.
- Advanced experience using a claims processing system.
- Must have contract configuration experience with Networx Pricer
- Experience with Benefits configuration using QNXT is highly preferred.
- Advanced experienced verifying documentation related to updates/changes within a claims processing system.
- Advanced 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
- High attention to detail.
- Effective verbal and written communication skills.
- Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.
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 5 years of configuration information management experience maintaining databases, or analyst experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs
- Advanced experience using a claims processing system
- Contract configuration experience with Networx Pricer
- Benefits configuration using QNXT
- Advanced experience verifying documentation related to updates/changes within a claims processing system
- Advanced experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, and fee schedules
- Analytical and critical-thinking skills
- Flexibility to meet changing business requirements and commitment to high-quality/on-time delivery
- High attention to detail
- Effective verbal and written communication skills
- Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables)
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.
