JOB DESCRIPTIONJob SummaryResponsible for accurate and timely production review of issues reported within our claims intake and processing ecosystem (QNXT, Edifecs, etc.). Gains understanding of solution functionality through documentation review, identify root cause, validate root cause and extrapolate potential impact of issue. 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
Knowledge of configuration in QNXT preferred
Knowledge of claim pricing preferred
Strong SQL knowledge preferred
Edifecs knowledge preferred
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
Ability to work with internal and external stakeholders to gain solution knowledge.
Possesses or Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment with limited training and documentation.
Complex projects with some mentoring
Moderate to Simple projects without mentoring
Researches issues and sets up proof of concept tests.
JOB QUALIFICATIONSRequired EducationAssociate degree or equivalent combination of education and experienceRequired Experience3-4 YearsPreferred EducationBachelor's Degree or equivalent combination of education and experiencePreferred Experience5-6 YearsTo 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: $59,810.6 - $129,589.63 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.