Manager, Configuration (EDI - Claims) - Military Veterans
at Molina Healthcare
JOB DESCRIPTION
Job Summary
Manages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure adherence to business and system requirements of Health Plans as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
KNOWLEDGE/SKILLS/ABILITIES
- Meet and exceed all performance metrics and department goals.
- Understand conflicts with teams and provide solutions.
- Ensure all team members comply with company and legal requirements.
- Ensure tasks are completed with accuracy and efficiency. Sets the right priorities and systematically identifies the root cause of challenges.
- Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business.
- Develops standard operating procedures and guidelines for the Configuration team.
- Provides status reports and project updates to management and stakeholders.
- Ensure staff have all the resources they need to perform at a high level.
- Conduct performance reviews, training, and corrective action as appropriate.
- Understanding of complex payment methodologies
- Understanding of complex configuration solutions
- Advanced knowledge of health care benefits.
- Advanced knowledge of healthcare claims and claim processingfrom receipt through encounter submission.
- Ability to adopt and utilize work tracking software
- Strong business writing skills; proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio
- Advanced knowledge of Excelpreferred
- SQL knowledge preferred
- Coding certification preferred
- Knowledge of configuration in QNXT strongly preferred
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
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: $80,412 - $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
AZ
Molina believes every person, family and community deserves access to high-quality health care regardless of their situation. Our mission is to deliver effective, reliable and affordable health care to those who need it most. We strive to meet the physical, social and emotional needs of each member and to strengthen the communities we serve.
We do this by offering a holistic, community-based approach designed specifically to meet the individual needs of our members.
What started in 1980 as one clinic in Long Beach, aimed at addressing the disparities in access to quality health care, has grown into 19 health plans across the country. For over 40-years we’ve been improving the lives of our 5.1 million members across the country by pioneering health care services exclusively for those with government-sponsored health care.
As our membership has grown over the years, so has our commitment to the communities we serve. In 2020, we launched the MolinaCares Accord, which makes substantial investments to improve members’ access to health care.