Apply on Employer Site

Molina Healthcare · 2 weeks ago

Lead Analyst, Configuration Information Management - QNXT

Florida, United States

Full-time

Onsite

Senior Level

$66K/yr - $130K/yr

5+ years exp

Molina Healthcare is a managed care organization that provides healthcare services. The Lead Analyst for Configuration Information Management is responsible for overseeing the implementation and maintenance of critical information on claims databases and ensuring adherence to business and system requirements related to healthcare operations.

Health CareHospitalMedical

Responsibilities

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

Qualification

Configuration Information ManagementClaims Processing SystemData AnalysisProvider ContractingHealth Care OperationsMicrosoft Office SuiteAnalytical SkillsCritical ThinkingEffective CommunicationAttention to Detail

Required

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

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