Manager, Configuration - Marketplace Benefit Maintenance/QNXT - Remote

Molina Healthcare; Long Beach (CA); Remote; USD 90,000 - 120,000; Full time

Job summary

Molina Healthcare seeks a remote Manager of Configuration responsible for leading a team of Configuration Analysts. The role includes ensuring accurate claim database management and operational performance while adhering to health plan requirements. Ideal candidates will have extensive experience in marketplace implementation and configuration, strong SQL, and advanced knowledge in healthcare benefits.

Benefits

Competitive benefits and compensation package

Qualifications

• 5-7 years of experience in a managerial role.
• Advanced knowledge preferred in health care claims and configuration.
• Ability to manage and train team members effectively.

Responsibilities

• Manage a team of Configuration Analysts and oversee daily operations.
• Ensure accuracy in claims database management and compliance.
• Develop standard operating procedures for the Configuration team.

Skills

SQL

Understanding of QNXT Schema

Health care benefits knowledge

Claims processing knowledge

Business writing skills

Education

Bachelor's Degree

Graduate Degree

Tools

Microsoft Word

Microsoft Excel

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