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

Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems.Participates in defect resolution for assigned componentAssists 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 and Benefits configuration in QNXT or NetworxMust have knowledge on Medicare payment methodsExperience on Hospital payment methodology  & processing is essentialUnderstanding on hospital claims processing and configuration worksMedicare fee schedule knowledge is requiredMedicaid 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 Educationv

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: $54,373.27 - $110,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 06/03/2025