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JOB DESCRIPTION

Job Summary

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains 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.

KNOWLEDGE / SKILLS / ABILITIES

Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems.

Participates in defect resolution for assigned component

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 application upgrades and releases, including development and execution of some test plans.

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

Executes retroactive claims reports

Runs fee schedule & MRDT update processes

Writes complex ad-hoc reports

Writes complex permanent reports

Creates MRDT and other configuration update scripts

Pre and post validation of fee schedule, contract, and complex retro reports.

Manages all MRDT updates (CPT, HCPCS, ICD-10, NDC, Yost) including validating the pre-production reports, distribution to the HPs for approval, follow up and completion notifications.

Monitors RFC submission mailbox, submit RFCs in iServe, and notify the Analyst of completion.

Researches and reviews MRDT issues identified by the HPs and CIM to determine root cause of the issue and what updates are needed to resolve it.

Write requirements and test plans for reports and development projects for MRDT processes to be built by the TCIM Development team including new fee schedule processes.

Performs manual updates for MRDT, service group and fee schedule that are not made through the RFC process or are small in number.

Writes / runs simple SQL scripts to validate retro reports and pre-prod reports.

Monitors and tracks fee schedules progress providing updates to the HPs once they have been completed.

Monitors MRDT tables that do not have a standard update process in place to confirm that all HPs are up to date.

Understands QNXT, AutoQ, and MCG functionality. Requires assistance with schema from Tech resource or Lead Analyst.

Writes Requirements for BRDs / FRDs and Reports.

Complex requirements with some mentoring

Moderate to Simple requirements without needing mentoring

Works with Technical resource for schema / solution

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.