Analyst, Configuration Information Management- Healthplan Ops (Remote in GA)

Molina Healthcare; Santa Fe (NM); Remote; USD 77,000 - 129,000; Full time

Job summary

A leading healthcare provider is seeking a Data Management Specialist based in New Mexico. This role focuses on the accurate implementation and maintenance of claims databases and involves analyzing data, managing benefit plans, and resolving claims issues. Candidates should have an Associate degree and 2-5 years of experience, preferably with GA Medicaid. This position offers a competitive salary and benefits package.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• 2-5 years of relevant experience in claims or related field.
• GA Medicaid claims/reimbursement/coding experience is preferred.

Responsibilities

• Analyze and interpret data to determine configuration changes.
• Maintain and update benefit plans, provider contracts, and fee schedules.
• Research and resolve claim/encounter issues.

Skills

Data analysis

Coding

Problem-solving

Education

Associate degree or equivalent

Bachelor's Degree or equivalent (preferred)

Job description

Overview

Candidates must reside in Georgia. This role is responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing data among operational and claims systems, applying business rules as they pertain to each database, and validating data to meet customer requirements related to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

Responsibilities

• Analyze and interpret data to determine appropriate configuration changes.
• Accurately interpret state and/or federal benefits, contracts, and additional business requirements, and convert these terms to configuration parameters.
• Handle coding, updating, and maintaining benefit plans, provider contracts, fee schedules, and various system tables through the user interface.
• Apply experience to research and resolve claim/encounter issues, pended claims, and update systems as necessary.
• Work with fluctuating volumes of work and prioritize to meet deadlines and the needs of the user community.
• GA Medicaid claims/reimbursement/coding experience is highly preferred.

Job Qualifications

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

2-5 years

Preferred Education

Bachelor\'s Degree or equivalent combination of education and experience

Preferred Experience

5-7 years

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.