Molina Healthcare
Lead Analyst, Payment Integrity - REMOTE
Molina Healthcare, Long Beach, California, us, 90899
Overview
Employer Industry: Healthcare Services Why consider this job opportunity
Opportunity for career advancement and growth within the organization Competitive benefits and compensation package Chance to make a significant impact on health plan financial performance and operational outcomes Work in a collaborative environment with cross-functional teams Engage in strategic decision-making that influences business goals What to Expect
Provide lead-level support as a business analyst to drive health plan financial performance and operational initiatives Manage Scorable Action Items (SAIs) related to claims accuracy and overpayment recovery Collaborate with operational teams and stakeholders to identify and resolve issues proactively Translate strategic needs into clear requirements and actionable plans Validate findings and create summaries that support leadership decision-making What is Required
At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting Proven experience managing operational projects in provider reimbursement and claims payment integrity Strong knowledge of managed care claims coding and federal/state Medicaid payment rules Skilled in Excel and SQL for data analysis to inform business decisions Excellent written and verbal communication skills with the ability to synthesize complex information How to Stand Out
Experience with Medicare, Medicaid, and Marketplace lines of business Certification as a Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) Project management experience Familiarity with Medicaid-specific Scorable Action Items (SAIs) and Payment Integrity programs We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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Employer Industry: Healthcare Services Why consider this job opportunity
Opportunity for career advancement and growth within the organization Competitive benefits and compensation package Chance to make a significant impact on health plan financial performance and operational outcomes Work in a collaborative environment with cross-functional teams Engage in strategic decision-making that influences business goals What to Expect
Provide lead-level support as a business analyst to drive health plan financial performance and operational initiatives Manage Scorable Action Items (SAIs) related to claims accuracy and overpayment recovery Collaborate with operational teams and stakeholders to identify and resolve issues proactively Translate strategic needs into clear requirements and actionable plans Validate findings and create summaries that support leadership decision-making What is Required
At least 6 years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting Proven experience managing operational projects in provider reimbursement and claims payment integrity Strong knowledge of managed care claims coding and federal/state Medicaid payment rules Skilled in Excel and SQL for data analysis to inform business decisions Excellent written and verbal communication skills with the ability to synthesize complex information How to Stand Out
Experience with Medicare, Medicaid, and Marketplace lines of business Certification as a Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) Project management experience Familiarity with Medicaid-specific Scorable Action Items (SAIs) and Payment Integrity programs We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.
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