Healthcare Claims & Payment Integrity Analyst

Molina Healthcare, Inc.

United States

À distance

USD 80 000 - 110 000

Plein temps

Il y a 2 jours

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Résumé du poste

Molina Healthcare is seeking a specialist to support Payment Integrity through research and development of post-pay recovery concepts and claims edits. The role analyzes healthcare claims, medical billing and coding requirements, and reimbursement policies to identify overpayment opportunities and translate findings into concrete business requirements for technical implementation.

The position requires 2+ years in managed care or related fields, with strong analytical skills and proficiency in

Qualifications

At least 2 years of experience in a managed care organization, health insurance or related field.
Policy/government legislative review knowledge.
Strong analytical and problem-solving skills.
Proficient with Office Suite (Word, Excel, Outlook, Teams).

Responsabilités

Researches and develops post-pay Payment Integrity recovery concepts and claims edits by evaluating healthcare claims, reimbursement patterns, medical billing and coding requirements, and applicable regulatory and payer guidance.
Interprets CMS, NCCI, Medicaid, Medicare and other guidelines to support defensible claims-recovery logic.
Translates opportunities into detailed business requirements, including claim logic, coding criteria, inclusions/exclusions, and documentation for analytics and development teams.