Lead Configuration Quality / Audit Analyst

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 and audit 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. Lead and participate in audit initiatives, develop quality control framework, and collaborate cross-functionally to drive continuous improvement in configuration practices and outcomes

Responsibilities

• Trains staff on configuration functionality, enhancements, and updates.
• Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
• Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
• Creates management reporting tools to enhance communication on configurations updates and initiatives.
• Negotiates expected completion dates with Health Plans.
• Lead audits of claims and QNXT configuration to ensure accuracy, completeness, and compliance with internal policies and external regulations.
• Develop and maintain audit checklists, quality metrics, and reporting tools.
• Identify configuration errors and root causes through analysis; recommend corrective actions and process improvements.
• Develop and implement quality control procedures and best practices for configuration management.
• Monitor performance indicators and trends to proactively address quality issues.
• Maintain detailed documentation of audit findings, configuration changes, and quality metrics.
• Prepare and present audit reports to leadership and stakeholders.

Requirements

Education

Experience

Preferred Qualifications

Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $77,969 - $155,508 / ANNUAL

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