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.