JOB DESCRIPTION

　　Job Summary

　　Responsible for accurate and timely production support review of issues reported within our claims payment ecosystem (QNXT, Edifecs, etc.). Gains understanding of solution functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received on claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to identify defects in the solution or configuration during warranty period.

　　KNOWLEDGE/SKILLS/ABILITIES

　　Understanding of Healthcare EDI Claims transactions to identify resolution for invalid rejections

　　Understanding of complex claim payment methodologies

　　Understanding of configuration solutions

　　Ability to use critical thinking to analyze claim processing issues

　　Knowledge of healthcare claims and claim processing from receipt through encounter submission

　　Knowledge of configuration in QNXT strongly preferred

　　Acts as a team lead, handling escalated issues through to resolution, assigning and prioritizing work for other team members as needed.

　　Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.

　　Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.

　　Creates management reporting tools to enhance communication on configurations updates and initiatives.

　　Negotiates expected completion dates with Health Plans.

　　Writes complex ad-hoc reports

　　Assists manager in establishing standards, guidelines, and best practices for the team

　　Research and review new tools and techniques and provide recommendations to management

　　Interprets complex business problems and technical issues

　　Effectively communicates solutions through review meetings, written specifications, workflow diagrams, and/or proof of concept demonstrations

　　Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment

　　Develops and maintain standards and best practices for the team

　　Mentors junior analysts

　　Participates in or leads project meetings

　　Understands QNXT, AutoQ, and MCG functionality and schema

　　JOB QUALIFICATIONS

　　Required Education

　　Bachelor's Degree or equivalent combination of education and experience

　　Required Experience

　　5-6 Years

　　Preferred Education

　　Graduate Degree or equivalent experience

　　Preferred Experience

　　7+ Years

　　To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

　　Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

　　Pay Range: $65,791.66 - $142,548.59 / ANNUAL

　　*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.