Responsible for performing research and analysis of claims processing workflow including anomalies/discrepancies and developing a resolution for these findings. Addresses State client issues, inaccurate processes, tests claims, applies Federal and State guidelines and presents findings to the State client. Considered a Subject Matter Expert on Medicaid Business processes and works closely with Business Architects and Application Development Teams presenting client and contractual requirement data. Also responsible for maintaining and configuring the system with fee and reference updates on a regular bases. Determines best practices and suggests how to improve current practices. Develops recommendations to solve problems and issues related to business operations and maintains all required documentation is current and up-to-date.
. SKILLS AND REQUIREMENTS
- Associate’s Degree or equivalent experience.
- 1 - 2 years experience working with QNXT, preferably knowledge of version 4.6 or higher; Knowledge of Medicaid/Medicare claims processing preferred
- 1 -3 years experience in a healthcare and/or insurance claims processing environment
- Proficient in MS Office Suite
- Understanding of claims processing and Medicaid systems
- Analytic and critical thinking skills are required
- Ability to work independently, with minimal supervision
- Excellent verbal and written communication skills
- Monitors, researches and analyzes recurring claims processing issues and makes resolution recommendations to correct discrepancies and/or findings.
- Meets with client, business architects and serve as a Subject Matter Expert on multiple Stored Procedures and Desktop Processes and present findings and corrective recommendations.
- Runs daily and ad hoc queries to assist other units with their daily operational needs.
- Serves as Configuration Analyst on multiple special projects performing analysis, configuration, developing test cases, scenarios, and ensuring the business processes are functioning properly to meeting requirements.
- Develops documentation to track quality assurance of business processes and software upgrades/changes.
To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online. Be sure to let us know you are a current employee by selecting “Molina Employee (current) in the source section of the online application.
Molina Healthcare is an Equal Opportunity Employer (EOE). M/F/V/D
Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and...