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.
Pay Range: $65,791.66 - $142,548.59 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.