Manager, Configuration - Healthplan Ops (Remote in GA)

Molina Healthcare; Georgia; Remote; USD 80,000 - 157,000; Full time

Job summary

A healthcare organization based in Georgia is seeking a team manager for Configuration Analysts. Responsibilities include managing operational activities, ensuring data accuracy, and compliance with regulations. Candidates should have a Bachelor's degree, 5-7 years of relevant experience, and strong knowledge of healthcare claims. The role offers a competitive salary ranging from $80,412 to $156,803 annually, with a focus on operational excellence in healthcare management.

Benefits

Competitive benefits and compensation package

Equal Opportunity Employer

Qualifications

• Bachelor's Degree or equivalent education and experience.
• 5-7 years of experience in a relevant field.
• Graduate Degree preferred with 7-9 years of experience.

Responsibilities

• Manage operational activities for the Configuration team.
• Validate data on claims databases.
• Develop standard operating procedures.
• Conduct performance reviews and training.

Skills

Performance metrics

Conflict resolution

Accuracy and efficiency

Configuration solutions

Understanding of payment methodologies

Healthcare benefits knowledge

Microsoft Office proficiency

Excel

SQL knowledge

Coding certification

Configuration in QNXT

GA Medicaid experience

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent

Job description

JOB DESCRIPTION

***Candidates must reside in Georgia.****

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 processing from 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 Excel preferred
• SQL knowledge preferred
• Coding certification preferred
• Knowledge of configuration in QNXT strongly preferred
• GA Medicaid claims/ reimbursement/ coding experience is highly 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

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Pay Range: $80,412 - $156,803.45 / ANNUAL

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