JOB DESCRIPTION

　　Job Summary

　　Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

　　KNOWLEDGE/SKILLS/ABILITIES

　　Writes Requirements for BRDs/FRDs and Reports.

　　Must have strong communication skills.

　　Participates in the implementation and conversion of new and existing health plans.

　　Knowledge of EDI 837 files.

　　Writes/runs simple SQL scripts to validate retro reports and pre-prod reports.

　　Writes complex ad-hoc reports

　　Participates in defect resolution for assigned component

　　Monitors RFC submission mailbox, submit RFCs in iServe, and notify the Analyst of completion.

　　Write requirements and test plans for reports and development projects for MRDT processes to be built by the TCIM Development team including new fee schedule processes.

　　Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.

　　Understands QNXT, AutoQ, and MCG functionality. Requires assistance with schema from Tech resource or Lead Analyst.

　　Complex requirements with some mentoring

　　Moderate to Simple requirements without needing mentoring

　　Works with Technical resource for schema/solution

　　Manage projects from requirements to deployment, including work assignment, prioritization, issue triage etc.

　　Complex projects with some mentoring

　　Moderate to Simple projects without mentoring

　　Researches issues and sets up proof of concept tests.

　　Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.

　　Executes retroactive claims reports

　　Writes complex permanent reports

　　Pre and post validation of fee schedule, contract, and complex retro reports.

　　Researches and reviews MRDT issues identified by the HPs and CIM to determine root cause of the issue and what updates are needed to resolve it.

　　Performs manual updates for MRDT, service group and fee schedule that are not made through the RFC process or are small in number.

　　Monitors and tracks fee schedules progress providing updates to the HPs once they have been completed.

　　Monitors MRDT tables that do not have a standard update process in place to confirm that all HPs are up to date.

　　JOB QUALIFICATIONS

　　Required Education

　　Associate degree or equivalent combination of education and experience

　　Required Experience

　　3-4 Years

　　Preferred Education

　　Bachelor's Degree or equivalent combination of education and experience

　　Experience working on Edifecs is a plus.

　　Preferred Experience

　　5-6 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: $59,810.6 - $129,589.63 / ANNUAL

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