JOB DESCRIPTIONJob SummaryA successful candidate will have a balance of business insight, critical thinking, strong communication and analytical skills. Possess the ability to work independently, self-navigate organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses of action for remediation. This role will support processes for multiple lines of business as related to cost share accumulators.KNOWLEDGE/SKILLS/ABILITIES
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.
Completes analysis on retroactive claims reports
Pre and post validation of complex retro reports.
Submit RFCs in iServe, and validates after completion.
Researches and reviews issues identified by the HPs and CIM to determine root cause of the issue and what updates are needed to resolve it.
Write requirements and for reports and development projects for cost share accumulator processes to be built by the TCIM Development team.
Writes/runs simple SQL scripts to validate retro reports and pre-prod reports.
Monitors and tracks fee schedules progress providing updates to the HPs once they have been completed.
Understands QNXT and claims functionality. Requires assistance with schema from Tech resource or Lead Analyst.
Writes Requirements for BRDs/FRDs and Reports.
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
JOB QUALIFICATIONSRequired EducationAssociate degree or equivalent combination of education and experienceRequired Experience3-4 YearsPreferred EducationBachelor's Degree or equivalent combination of education and experiencePreferred Experience5-6 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 - $155,508 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
