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Molina Healthcare · 2 weeks ago

Senior Analyst, Configuration Information Management - QNXT

Florida, United States

Full-time

Onsite

Mid, Senior Level

$60K/yr - $118K/yr

3+ years exp

Molina Healthcare is seeking a Senior Analyst for Configuration Information Management. The role involves providing senior-level analyst support for managing configuration information, ensuring accurate implementation and maintenance of claims databases, and validating data in accordance with business and system requirements.

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

Serves as a departmental configuration information management subject matter expert

Participates in various department-wide configuration information management projects

Provides training and support to new and existing configuration information management team members

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 systemProvider contractingAnalytical skillsMicrosoft ExcelEffective communicationAttention to detailFlexibility

Required

At least 3 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 Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency