JOB DESCRIPTIONJob 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
Trains staff on configuration functionality, enhancements, and updates.
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.
Must have experience working on QNXT/Medicare/NetworX
Must have experience working on SQL.
Medicare claims experience is a huge plus
Medicare Fee Schedule knowledge is desired.
Must be able to work in a fast paced environment while also meeting the SLAs and high volume work.
JOB QUALIFICATIONSRequired EducationBachelor's Degree or equivalent combination of education and experienceRequired Experience7-9 yearsPreferred EducationGraduate Degree or equivalent experiencePreferred Experience10+ 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: $59,810.6 - $129,589.63 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
