Senior Provider Reimbursement Analyst

Molina Healthcare, Inc.; Oregon; Hybrid; USD 75,000 - 95,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare is seeking a senior analyst to provide reimbursement support across Medicaid, Medicare, and Marketplace programs. You will analyze complex provider reimbursement methods, including PPS pricing, fee-for-service, and value-based models, and work with IT and pricing software vendors to implement changes.

The role requires 3+ years in provider reimbursement within managed care, strong Excel skills, and the ability to translate policies into test plans and claims configuration.

Qualifications

• At least 3 years of complex provider reimbursement experience in a managed care setting.
• Experience with Medicaid, Medicare, and Marketplace programs.
• Advanced experience using a claims processing system.
• Strong analytical and communication skills.

Responsibilities

• Research reimbursement methodologies for Medicaid, Medicare, and Marketplace providers.
• Leverage expertise in reimbursement groupers (APG, EAPG, APR-DRG, MS-DRG, etc.).
• Support implementation of new prices including testing plans and system changes.
• Ensure price maintenance and QA across deployment activities.
• Collaborate with IT and pricing software vendors to resolve issues.
• Identify automation and improvement opportunities.
• Provide training and support to reimbursement team members.
• Manage fluctuating work volumes to meet deadlines.

Skills

Analytical thinking

Verbal & written communication

Excel

Tools

Claims processing system

Excel

Job description

Molina Healthcare is seeking a senior analyst to provide reimbursement support across Medicaid, Medicare, and Marketplace programs. You will analyze complex provider reimbursement methods, including PPS pricing, fee-for-service, and value-based models, and work with IT and pricing software vendors to implement changes.

The role requires 3+ years in provider reimbursement within managed care, strong Excel skills, and the ability to translate policies into test plans and claims configuration.