Molina Healthcare
Senior Business Analyst - Medicaid Claims Payments
Molina Healthcare, Long Beach, California, us, 90899
Job Summary:
Join our team as a Senior Business Analyst specializing in Medicaid Claims Payments. In this dynamic role, you will support the Senior Leadership Team by providing expert guidance on intricate claims-related issues and service recovery initiatives. Your analytical skills will be crucial in solving complex business problems using data from various sources, equipping decision-makers with vital insights. You will identify trends and patterns within datasets, forecast outcomes, and develop strategic recommendations. Key Responsibilities: Analyze complex business problems and provide insight into decision-making. Create reports and specifications based on business needs and available data. Collaborate with clients to customize analysis and reporting to their specific requirements. Engage in management reviews, presenting and interpreting analytical results, and making actionable recommendations. Gather requirements through interviews, workshops, and documentation analysis; translate business needs into requirements effectively. Work closely with operational leaders to identify opportunities for process improvements and enhance medical cost savings or revenue. Develop Business Requirements Documents, Test Plans, User Training materials, and other essential documentation. Support all stages of project development, including research, design, and implementation. Provide Level II claims support to internal teams and directly with providers as needed. Monitor and resolve work queues related to timely claims payments and encounters processing. Qualifications: Required Education:
Bachelor's Degree or equivalent experience. Required Experience:
5-7 years in business analysis with a focus on claims payment accuracy; 6+ years in managed care (preferably in Payer Claims environment). Proficiency in claims processing concepts including Provider Data, Claims Configuration, and Claims Adjudication. Preferred Experience:
3-5 years troubleshooting claims escalations; direct provider interaction experience. Experience working with technical teams and familiarity with Medicaid and Medicare regulations. Familiarity with QNXT, coding, SQL, and Salesforce. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.
Join our team as a Senior Business Analyst specializing in Medicaid Claims Payments. In this dynamic role, you will support the Senior Leadership Team by providing expert guidance on intricate claims-related issues and service recovery initiatives. Your analytical skills will be crucial in solving complex business problems using data from various sources, equipping decision-makers with vital insights. You will identify trends and patterns within datasets, forecast outcomes, and develop strategic recommendations. Key Responsibilities: Analyze complex business problems and provide insight into decision-making. Create reports and specifications based on business needs and available data. Collaborate with clients to customize analysis and reporting to their specific requirements. Engage in management reviews, presenting and interpreting analytical results, and making actionable recommendations. Gather requirements through interviews, workshops, and documentation analysis; translate business needs into requirements effectively. Work closely with operational leaders to identify opportunities for process improvements and enhance medical cost savings or revenue. Develop Business Requirements Documents, Test Plans, User Training materials, and other essential documentation. Support all stages of project development, including research, design, and implementation. Provide Level II claims support to internal teams and directly with providers as needed. Monitor and resolve work queues related to timely claims payments and encounters processing. Qualifications: Required Education:
Bachelor's Degree or equivalent experience. Required Experience:
5-7 years in business analysis with a focus on claims payment accuracy; 6+ years in managed care (preferably in Payer Claims environment). Proficiency in claims processing concepts including Provider Data, Claims Configuration, and Claims Adjudication. Preferred Experience:
3-5 years troubleshooting claims escalations; direct provider interaction experience. Experience working with technical teams and familiarity with Medicaid and Medicare regulations. Familiarity with QNXT, coding, SQL, and Salesforce. Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.