Job Description
Job Description
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
• 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.
• Extensive experience on researching, presenting and documenting is required,
• Experience with Medicare, Medicaid and Marketplace is required.
• Medical coding experience is highly preferred.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent experience
Preferred Experience
10+ 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.
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
• 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.
• Extensive experience on researching, presenting and documenting is required,
• Experience with Medicare, Medicaid and Marketplace is required.
• Medical coding experience is highly preferred.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
7-9 years
Preferred Education
Graduate Degree or equivalent experience
Preferred Experience
10+ 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.
💡 Quick Summary
Seeking a career-building opportunity? The Lead Analyst, Claims / Regulatory Compliance position is now open for candidates interested in the Operations Executive Jobs sector. This role in Houston offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Operations Executive Jobs is a plus.
