JOB DESCRIPTION
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
Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems.
Participates in defect resolution for assigned component
Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.
Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.
Participates in the implementation and conversion of new and existing health plans.
Must have experience in Contracts configuration in QNXT or Networx
Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required.
Must have knowledge on Medicare payment methods
Experience on Hospital payment methodology & processing is essential
Understanding on hospital claims processing and configuration works
Medicare fee schedule knowledge is required
Medicaid and Duals experience is highly preferred
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method.
Preferred Education
Graduate Degree or equivalent experience
Medicaid and Duals expeirence is preferred.
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: $83,252 - $141,371 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Senior QNXT Analyst - Contract Configuration • Bellevue, NE, United States
In an increasingly complex world where people are starving for someone they can trust, we stand for something simple: always put the client first.We do well by doing good for those we serve.We beli...Show more
As a contract registration analyst at Gallup, you'll bring clarity and precision to the financial details that sustain our client partnerships and operational excellence.You'll transform complex co...Show more
Argo and Farm Family are specialty property and casualty insurance brands whose underwriting companies are wholly-owned subsidaries of Clearbrook Holdings Inc.Argo and Farm Family partner with agen...Show more
Billing Transformation Compliance Analyst.Segra is searching for a qualified and experienced Billing Transformation Compliance Analyst to join us in a full-time capacity.This work arrangement for t...Show more
Senior Financial Billing Analyst, Contract Implementation.Calling all innovators find your future at Fiserv.We're Fiserv, a global leader in Fintech and payments, and we move money and information ...Show more
QA Analyst/Quality Engineer Duration: 6+ Months Location: Omaha, NE- Onsite Responsibilities: Show more
Current Employees and Contractors Apply Here.Opportunity in Financial Services.Actual compensation offered will be determined individually, based on several job-related factors, including location,...Show more
Days Onsite Contract 8+ Years of experience Credit/Debit/Prepaid Card, Card Schemes, Agile.Show more
Job Title :Guidewire Business Analyst Location : Omaha, NE-onsite Contract The Business Analyst will play a crucial role in ensuring that the business requirements ne...Show more
This job investigates customer activity across multiple platforms to ensure that it falls within acceptable parameters established by governing bodies including, but not limited to, the Financial C...Show more
Atria Group LLC is seeking an experienced Enterprise Architect specialized in safety-critical systems development.The role focuses on preparing enterprise architecture and ensuring compliance with ...Show more
Calling all innovators find your future at Fiserv.We're Fiserv, a global leader in Fintech and payments, and we move money and information in a way that moves the world.We connect financial institu...Show more
About Einsightful LLC: At Einsightful LLC, our success is driven by our talented team and our commitment to their professional growth.We are a cross-functional shared service organization providing...Show more
Join a Mission-Driven Team at The GARRETT GROUP.When you join us, you become part of a collaborative, mission-focused community committed to excellence in everything we do.We take pride in supporti...Show more
Is this you? Are you an experienced Backup and Disaster Recovery Engineer with a passion for assisting customer support needs?.Do you want to be a part of an innovative team in the cloud space?.If ...Show more
As a Compliance Analyst, you will ensure Orion complies with all legal, regulatory, and internal requirements while supporting the firm's Investment Adviser and Broker-Dealer compliance programs.Th...Show more
Responsible for planning, awarding, and administering complex, high-value acquisitions in a high-tempo, mission-focused environment.Oversees workload management, provides acquisition leadership thr...Show more
Serious Medicine is what we do.Being extraordinary is who we are.Every colleague plays a key role in upholding this promise to our patients and their families.Shift: First Shift (United States of A...Show more
