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
Analyze and interpret data to determine appropriate configuration changes.
Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
Handles coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.
Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.
Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community.
Must be able to do deep dive root cause analysis and research on claims
JOB QUALIFICATIONS
Required Education
Associate degree or equivalent combination of education and experience
Required Experience
2-5 years
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
5-7 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: $49,430.25 - $107,098.87 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
