JOB DESCRIPTIONJob SummaryJob SummaryResponsible 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
Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems.
Participates in defect resolution for assigned component
Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.
Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.
Participates in the implementation and conversion of new and existing health plans.
Must have experience on claims processing system, benefit configuration.
SQL knowledge is preferred.
Healthcare experience is required,
Experience working in a managed care environment and commercial line of business is preferred.
JOB QUALIFICATIONSRequired EducationBachelor's Degree or equivalent combination of education and experienceRequired Experience5-7 years of QNXT exp, config/ healthcarePreferred EducationGraduate Degree or equivalent experiencePreferred Experience7-9 yearsTo 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: $67,725 - $141,371 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
