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JOB DESCRIPTION

Job Summary

Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.

KNOWLEDGE/SKILLS/ABILITIES

+ Generates data to support continuous quality of provider data and developing SOPs and/or BRDs.

+ Develops and maintains documentation and guidelines for all assigned areas of responsibility.

+ Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.

+ Assists in planning and coordination of the claim payment system upgrades and releases, including development and execution of some test plans.

+ Participates in the implementation and conversion of new and existing health plans.

+ Collaborate with stakeholders to understand business objectives, gather requirements, and translate them into comprehensive business and functional specifications.

+ Analyze complex healthcare data sets to identify trends, patterns and insights that drive informed decision-making and process improvements.

+ Evaluate existing workflows, procedures, and systems to identify inefficiencies and opportunities for optimization, proposing and implementing innovative solutions.

+ Lead and support cross-functional projects from initiation to completion, ensuring adherence to timelines and quality standards.

+ Establish and maintain strong relationships with key stakeholders ensuring alignment and collaboration across departments.

+ Develop presentations to communicate key metrics, performance indicators and actionable insights to stakeholders at all levels of the organization.

+ Provide training, support, and guidance to end-users on new processes, systems, and tools, ensuring smooth implementation and adoption.

• SQL language experience, including scripting, developing, creating new scripts for report building and creation.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

7-9 years

SQL

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: $77,969 - $141,371 / ANNUAL

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