Claims Analyst, Configuration Information Management

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely implementation and oversight of 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. This position's primary responsibility and focus will be related to the Texas Medicaid Directed Payment Program (DPP).

Responsibilities and Requirements

• Analyze and interpret data to determine appropriate configuration changes.
• Accurately interprets specific state and / or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
• Coordinate / Facilitate coding updates related to benefit plans, provider contracts, fee schedules and various system tables through the user interface.
• Apply previous experience and knowledge to research and resolve claim / encounter issues, pended claims and facilitate system update(s) as necessary.
• Works with fluctuating volumes of work and is able to prioritize work to meet deadlines and needs of user community.

Qualifications

Associate degree or equivalent combination of education and experience

Required Experience : 2-5 years

Preferred Education : Bachelor's Degree or equivalent combination of education and experience

Preferred Experience : 5-7 years

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $54,922 - $107,099 / ANNUAL

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

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