Molina Healthcare Remote Sr Analyst, Config Info Mgmt in Long Beach, California
This role analyzes the configuration of the QNXT system
Responsible for completing analysis of the claims and QNXT system configuration to identify trends and opportunities for automation.
Creates analysis documents to report findings, coordinates discussions with internal CIM staff and health plan partners and finalizes action items.
Participates in automation related projects, submits work requests when needed, works with TCIM and IT to define business requirements, ensures CIM related activities are completed accurately and in a timely manner and validates results.
Monitors mass adjudication rates across the organization to identify trends and proactively determine causes of significant spikes or drops in rates.
QNXT configuration in contracts, benefits, MRDTs, etc.
Strong understanding of claims processes, provider set-up, prior authorization requirements and their relationships within QNXT
Ability to define business requirements and/or complex issues in a clear, concise manner.
Knowledge of AutoQ or MCG processes a plus
Demonstrated analytical and problem-solving skills
Excellent verbal and written communication skills
Responsible 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.
Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 5-7 years Preferred Education Graduate Degree or equivalent experience Preferred Experience 7-9 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.
Job: *Core Operations
Title: Remote Sr Analyst, Config Info Mgmt
Location: CA-Long Beach-Remote Employees
Requisition ID: 1802905