Senior Configuration Analyst II (3651BR) Houston, Texas
Responsible for accurately interpreting specific State and/or Federal Benefits, Contracts as well as additional business requirements and converting these terms to configuration parameters. This position is also responsible for coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.
• Analyze by applying knowledge and experience to ensure appropriate information has been provided.
• Thoroughly understand health plan’s environment and how QNXT software can be used tin increase efficiencies, cost effectiveness and quality care.
• Problem solve with Health Plans and Corporate to ensure all end to end business requirements have been documented.
• Works with internal and external stakeholders to understand business objectives and processes associated with the Medicaid enterprise.
• Assist in planning and coordination of application upgrades and releases, including development and execution of some test plans.
• Demonstrate ingenuity self-reliance and resourcefulness. Able to take action without instructions using attained business knowledge which is applied consistent with current configuration and operations.
• Participates in defect resolution for assigned component.
• Proven track record as lead and the ability to analyze interpret and implement business requirements.
• Ability to work in a consultative capacity.
• Suggest improvement processes to ensure systems are working more efficiently and improve quality.
• Load and maintain provider, contract, benefit or reference table information into computer system(s).
• Conduct Unit Testing when appropriate.
• Train staff on configuration enhancements & updates.
• Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary.
• Apply knowledge of interfaces and other applications to research and resolve issues and update system(s) as necessary.
• Support Claims staff with complex claims issues.
• Collaborate with team members to share experience and knowledge.
• Lead in Projects for both Configuration and Corporate initiatives.
• Lead new implementation and conversion support of QNXT application within the scope of CIM Departmental responsibilities.
• Assistance with quality audit review and performance
• Identifying and developing process improvements outside daily scope of work
• Participate in business requirement collection and documentation
• Assists with development of configuration standards and best practices
• Maintain thorough and concise documentation for tracking of all provider, contract, benefit or reference table configuration change request forms (CCRF) for quality audit purposes.
• Weight complexity for all requests received.
• Monitor claims queues to identify issues, makes recommendations, and implements configuration changes to improve claims TAT and accuracy.
• Ability to handle fluctuating volumes of work and be able to prioritize work to meet deadlines and needs of user community.
• Creates management reporting tools to enhance communication on configurations updates and initiatives.
• Handle special projects and demonstrate ability to meet deadlines.
• Other duties, as assigned.
• Expert level of knowledge in Microsoft applications
• Expert level of knowledge in medical terminology, ICD-9, CPT and HCPC
• Knowledge of SQL
• Works with technical staff for interface testing, data load validation and other data related tasks as assigned
• Ability to work independently as well as within a team
• Analytical and problem solving skills
• Deductive and inductive thinking
• Attention to detail and accuracy
• Ability to meet department standards of turnaround time and quality
• Demonstrate consistent multi-tasking skills and planning for prioritizing workload with focus on deadlines in multiple health plans.
• Utilize effective verbal and written communication skills for external and internal departmental relations
• Advanced verbal and written communication skills
• Ability to articulate complex configuration solutions
• Advanced presentation skills
• Ability to abide by Molina’s policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
• Healthcare experience: 10 + years healthcare experience
• Claims Operations or application vendor experience: 5 + years
• Benefit and Contract Configuration experience: 3+ years
• Experience interpreting benefits, contracts and other business requirements: 5+ years
• Experience in medical coding initiatives and coding guidelines: 3 + years
• QNXT Professional certification required
• Bachelor’s degree preferred. Years of experience in lieu of education are acceptable.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.