Senior QNXT Analyst - Benefits/ Contract Configuration

Molina Healthcare; Bellevue (WA); On-site; USD 77,000 - 142,000; Full time

Job summary

A healthcare organization in Bellevue is seeking a professional to manage critical information on claims databases. The ideal candidate will have 5-7 years of experience in SQL and Medicare, with a Bachelor's degree required. Responsibilities include synchronizing data across systems and ensuring adherence to contracting and benefit requirements. Competitive compensation of $77,969 - $141,371 annually is offered.

Benefits

Competitive benefits package

Qualifications

• 5-7 years in SQL, Medicare, Networx, QNXT, claims processing, and hospital claims payment method.
• Experience in planning and coordinating application upgrades.
• Strong knowledge of Medicare fee schedule.

Responsibilities

• Implement and maintain critical information on claims databases.
• Synchronize data among operational and claims systems.
• Assist in planning and coordination of application upgrades.

Skills

SQL

Contracts and Benefits configuration in QNXT or Networx

Medicare payment methods

Hospital payment methodology & processing

Understanding on hospital claims processing

Medicaid and Duals experience

Education

Bachelor's Degree or equivalent

Graduate Degree or equivalent experience

Job description

Overview

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

Knowledge/Skills/Abilities

• Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems.
• Participates in defect resolution for assigned component
• Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality.
• Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.
• Participates in the implementation and conversion of new and existing health plans.
• Must have experience in Contracts and Benefits configuration in QNXT or Networx
• Must have knowledge on Medicare payment methods
• Experience on Hospital payment methodology & processing is essential
• Understanding on hospital claims processing and configuration works
• Medicare fee schedule knowledge is required
• Medicaid and Duals experience is highly preferred

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method.

Preferred Education

Graduate Degree or equivalent experience

Medicaid and Duals expeirence is preferred.

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: $77,969 - $141,371 / ANNUAL

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