Manager, Configuration - Benefit Maintenance/QNXT - Remote

Molina Healthcare; Ohio; Remote; USD 80,000 - 189,000; Full time

Job summary

Molina Healthcare recherche un Manager, Configuration pour superviser une équipe d'analystes. Ce rôle comprend l'implémentation et la maintenance des systèmes critiques concernant les bases de données de réclamations. Le candidat idéal aura une solide expérience en configuration et en SQL, avec des qualifications en gestion et une compréhension des solutions et méthodologies complexes.

Benefits

Competitive benefits package

Equal Opportunity Employer (EOE)

Qualifications

• 5-7 ans d'expérience requise, 7-9 ans préférée.
• Compréhension des méthodologies de paiement complexes.
• Certification de codage et connaissance de QNXT préférées.

Responsibilities

• Gérer une équipe de Configuration Analysts pour une mise en œuvre précise des données.
• Développer des procédures opérationnelles pour l'équipe.
• Fournir des rapports de statut aux parties prenantes.

Skills

Marketplace implementation experience

Marketplace benefit configuration experience

Strong SQL skills

Understanding of the QNXT Schema

Advanced knowledge of health care benefits

Understanding of complex payment methodologies

Advanced knowledge of healthcare claims processing

Strong business writing skills

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft Teams

Microsoft SharePoint

Microsoft PowerPoint

Microsoft Visio

Job description

Molina Healthcare is in search of a Manager, Configuration. This role is remote and can be worked from a variety of locations.

Highly Qualified Candidates Will Have The Following Experience-

• Marketplace implementation experience
• Marketplace benefit configuration experience
• Marketplace and/or Commercial experience
• Strong SQL skills
• Understanding of the QNXT Schema

Job Summary

Manages a team of professional Configuration Analysts. Responsible for operational activities for the assigned team, including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure adherence to business and system requirements of Health Plans as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

KNOWLEDGE/SKILLS/ABILITIES

• Meet and exceed all performance metrics and department goals.
• Understand conflicts with teams and provide solutions.
• Ensure all team members comply with company and legal requirements.
• Ensure tasks are completed with accuracy and efficiency. Sets the right priorities and systematically identifies the root cause of challenges.
• Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business.
• Develops standard operating procedures and guidelines for the Configuration team.
• Provides status reports and project updates to management and stakeholders.
• Ensure staff have all the resources they need to perform at a high level.
• Conduct performance reviews, training, and corrective action as appropriate.
• Understanding of complex payment methodologies
• Understanding of complex configuration solutions
• Advanced knowledge of health care benefits.
• Advanced knowledge of healthcare claims and claim processingfrom receipt through encounter submission.
• Ability to adopt and utilize work tracking software
• Strong business writing skills; proficient user of Microsoft Products including Word, Excel, Outlooks, Teams, SharePoint, PowerPoint, and Visio
• Advanced knowledge of Excelpreferred
• SQL knowledge preferred
• Coding certification preferred
• Knowledge of configuration in QNXT strongly preferred

JOB QUALIFICATIONS

Required Education: Bachelor's Degree or equivalent combination of education and experience
Preferred Education Graduate Degree or equivalent combination of education and experience

Required Experience 5-7 years
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: $80,412 - $188,164 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.