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

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

　　Knowledge of configuration in QNXT preferred

　　Strong SQL knowledge required

　　Ability to write complex queries for impact analysis

　　Writes complex ad-hoc reports

　　Understanding of Healthcare EDI Claims transactions preferred

　　Understanding of complex claim payment methodologies

　　Understanding of configuration solutions preferred

　　Ability to use critical thinking to analyze claim processing issues

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

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

　　Participates in defect resolution for assigned component

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

　　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.

　　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

　　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.