JOB DESCRIPTION
Job Summary
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
- 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.
- Writes complex ad-hoc reports
- Creates complex MRDT and other configuration update scripts
- Assists manager in establishing standards, guidelines, and best practices for the team
- Designs and develop templates for complex reports and automated configuration processes/solutions
- Assist manager in establishing peer review standards and methodology
- Leads peer reviews
- Leads the design and development of large, complex, critical configuration maintenance processes/solutions
- Research and review new tools and techniques and provide recommendations to management
- Builds complex configuration processes/solutions
- Maintains MRDT, fee schedule, premium, AutoQ, and other file load packages
- Designs/document AutoQ solutions (FRD, Schema, etc.)
- Interprets complex business problems and technical issues
- Architects and design comprehensive solutions that meet the business and technical requirements for the given initiative
- Effectively communicates solutions through review meetings, written specifications, workflow diagrams, and/or proof of concept demonstrations
- Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle
- Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment
- Develops and maintain standards and best practices for the team
- Mentors junior analysts
- Participates in or leads project meetings
- Understands QNXT, AutoQ, and MCG functionality and schema
- Determines if a project is AutoQ, MCG, or other
- Writes Requirements for BRDs/FRDs and Reports without needing mentoring
- Suggests schema/solution. Works with technical resource to determine best solution.
- Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc.
- Understands QNXT, AutoQ, and MCG functionality and schema
- Determines if a project is AutoQ, MCG, or other
- Writes Requirements for BRDs/FRDs and Reports without needing mentoring
- Suggests schema/solution. Works with technical resource to determine best solution.
- Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc.
- Researches complex issues, and set up complicated proof of concept tests without needing mentoring
- E.g., Medicare Exclusion POC
- Acts as a team lead, assigning and prioritizing work for other team members as needed.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-6 Years
Preferred Education
Graduate Degree or equivalent experience
Preferred Experience
7+ 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.
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