Lead QNXT Analyst, Benefits Configuration

Molina Healthcare; Grand Rapids (MI); On-site; USD 77,000 - 156,000; Full time

Job summary

A healthcare services company is seeking a qualified candidate for a role focused on maintaining claims databases and synchronizing critical data across operational systems. The position requires extensive experience in benefit configuration and a strong background in SQL. This role offers a competitive salary and benefits package, commensurate with experience.

Benefits

Competitive benefits package

Qualifications

• Bachelor's Degree or equivalent combination of education and experience.
• 7-9 years of relevant experience required.
• Graduate Degree or equivalent experience preferred.
• 10+ years of experience preferred.

Responsibilities

• Responsible for maintaining claims databases.
• Synchronizes data among operational and claims systems.
• Validates data housed on databases and adheres to business requirements.

Skills

Working with internal and external stakeholders

Problem solving with Health Plans

Creating management reporting tools

Cross-functional teamwork

QNXT benefit configuration experience

SQL proficiency

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent experience

Tools

QNXT

Networx

SQL

Job description

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

• Trains staff on configuration functionality, enhancements, and updates.
• Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
• Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
• Creates management reporting tools to enhance communication on configurations updates and initiatives.
• Negotiates expected completion dates with Health Plans.
• Candidates must be able to work in a cross functional teams
• Must be able to implement new business.
• Must have experience in benefit configuration in QNXT and act as a QNXT SME.
• Networx / Pricer and claims experience is highly preferred.
• SQL is highly preferred.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Education

Graduate Degree or equivalent experience

Preferred Experience

10+ 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 - $155,508 / ANNUAL

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