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JOB DESCRIPTION

Job Summary

Responsible for accurate and timely review of production support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains understanding of solution functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received on claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to identify defects in the solution or configuration during warranty period.

KNOWLEDGE/SKILLS/ABILITIES

+ Knowledge of healthcare claims and claim processing from receipt through encounter submission

+ Strong Knowledge in QNXT required

+ Knowledge of Edifecs strongly preferred

+ Strong SQL knowledge required

+ Ability to write complex queries for impact analysis

+ Writes complex ad-hoc reports

+ Understanding of Healthcare EDI Claims transactions preferred

+ Understanding of complex claim payment methodologies

+ Understanding of configuration solutions preferred

+ Ability to use critical thinking to analyze claim processing issues

+ Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.

+ Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment

+ Participates in defect resolution for assigned component

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

+ Manage projects from requirements to deployment, including work assignment, prioritization, issue triage etc.

+ Complex projects with some mentoring

+ Moderate to Simple projects without mentoring

+ Researches issues and sets up proof of concept tests.

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

3-4 Years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-6 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: $77,969 - $155,508 / ANNUAL

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