Manager, Configuration - Benefits/Regulatory Requirements - Remote

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

Job summary

Molina Healthcare is seeking a Configuration Manager to lead a team of analysts, ensuring accurate implementation and maintenance of claims databases. This position requires extensive knowledge of healthcare benefits and claims processing. The ideal candidate will have strong leadership skills and experience in managing complex configurations.

Qualifications

• 5-7 years of experience required; 7-9 years preferred.
• Understanding of QNXT configuration is strongly preferred.
• Coding certification preferred.

Responsibilities

• Manage team of Configuration Analysts and ensure operational activities.
• Develop procedures and guidelines for the Configuration team.
• Work with business teams on configuration solutions.

Skills

Meet and exceed performance metrics

Provide solutions to conflicts

Ensure compliance with requirements

Accurate and efficient task completion

Configuration design and solutions

Develop standard operating procedures

Conduct performance reviews

Understanding of complex payment methodologies

Advanced knowledge of health care benefits

Strong business writing skills

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent (preferred)

Tools

Microsoft Products

SQL

Job description

JOB DESCRIPTION

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

Required Experience

5-7 years

Preferred Education

Graduate Degree or equivalent combination of education and experience

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.