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- Promoted
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Specialty Claims Adjuster
VirtualVocationsLas Cruces, New Mexico, United StatesManager, Configuration (EDI - Claims)
Molina HealthcareLas Cruces, NM, United StatesJOB DESCRIPTION
Job Summary
Manages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure adherence to business and system requirements of Health Plans as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
KNOWLEDGE / SKILLS / ABILITIES
Meet and exceed all performance metrics and department goals.
Understand conflicts with teams and provide solutions.
Ensure all team members comply with company and legal requirements.
Ensure tasks are completed with accuracy and efficiency. Sets the right priorities and systematically identifies the root cause of challenges.
Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business.
Develops standard operating procedures and guidelines for the Configuration team.
Provides status reports and project updates to management and stakeholders.
Ensure staff have all the resources they need to perform at a high level.
Conduct performance reviews, training, and corrective action as appropriate.
Understanding of complex payment methodologies
Understanding of complex configuration solutions
Advanced knowledge of health care benefits.
Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission.
Ability to adopt and utilize work tracking software
Strong business writing skills; proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio
Advanced knowledge of Excel preferred
SQL knowledge preferred
Coding certification preferred
Knowledge of configuration in QNXT strongly preferred
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience
Required Experience
5-7 years
Preferred Education
Graduate Degree or equivalent combination of education and experience
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 : $80,412 - $188,164 / ANNUAL
- Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.