JOB DESCRIPTION

Job Summary

Analyzes complex business problems and issues within Payment Integrity Pre-Pay using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Works with CPT, HCPCS, ICD-9 and ICD-10 coding systems within Medicare & Medicaid regulations. Will support stakeholders with claims processing, reimbursement concepts, and identifying trends, discrepancies and opportunities for cost avoidance.

KNOWLEDGE/SKILLS/ABILITIES

• Provides analytical, problem solving foundation including: definition and documentation, specifications.

• Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

• Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.

• Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.

• Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met

• Prepares high level user documentation and training materials as needed.

JOB QUALIFICATIONS

Required Education

Associate's Degree or equivalent combination of education and experience

Required Experience

• 3-5 Years of business analysis

• 4+ years managed care experience

• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

• Understanding Medicare and Medicaid regulations

• Understanding claims processing and reimbursement concepts

• Proficiency in analyzing healthcare data to identify trends, discrepancies, and opportunities for cost avoidance

• Strong analytical thinking skills

• Excellent verbal and written communication skills

• The ability to work effectively with cross-functional teams and establish credibility

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: $21.82 - $51.06 / HOURLY

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