Molina Healthcare
Claims Analyst, Configuration Information Management
Molina Healthcare, Long Beach, California, us, 90899
JOB DESCRIPTION
Responsible for accurate and timely implementation and oversight of 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. This position’s primary responsibility and focus will be related to the Texas Medicaid Directed Payment Program (DPP). 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. Coordinate/Facilitate coding, updates related to 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 facilitate system update(s) as necessary. Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community. 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 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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Responsible for accurate and timely implementation and oversight of 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. This position’s primary responsibility and focus will be related to the Texas Medicaid Directed Payment Program (DPP). 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. Coordinate/Facilitate coding, updates related to 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 facilitate system update(s) as necessary. Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community. 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 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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