We are looking for a Sr. Configuration Analyst for a long term project!
Summary: Responsible for the daily configuration maintenance within the Configuration Information Management (CIM) Operations Team. Under general supervision, responsible for interpreting specific State and/or Federal Benefits, Contracts as well as additional business requirements and converting these terms to configuration parameters. Also responsible for coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface.
Essential Functions: ? Receive information from Health Plan or Corporate for update of information in computer system(s). ? Analyze data by applying knowledge and experience to ensure appropriate information has been provided. ? Apply previous experience and knowledge to research and resolve claim/encounter issues, pended claims and update system(s) as necessary. ? Analyze and interpret data to determine appropriate configuration changes. ? Unit test simple configuration changes. ? Maintain thorough and concise documentation for tracking of all provider, contract, benefit or reference table configuration change request forms (CCRF) for quality audit purposes. ? Monitor claims queues to identify issues, makes recommendations, and implements configuration changes to improve claims TAT and accuracy. ? Support Claims staff with simple to moderate claims issues. ? Collaborate with team members to share experience and knowledge. ? Demonstrate consistent multitasking skills and planning for prioritizing workload with a focus on deadlines in multiple health plans.
Knowledge/Skills/Abilities: ? Intermediate level of knowledge in Microsoft applications ? Intermediate level of knowledge in medical terminology, ICD-9, CPT and HCPC ? Ability to work independently as well as within a team ? Analytical and problem solving skills ? Deductive and inductive thinking ? Attention to detail and accuracy ? Ability to meet department standards of turnaround time and quality ? Multi-tasking skills and planning for prioritizing workload ? Strong verbal and written communication skills ? Ability to articulate simple to moderate configuration solutions ? Ability to abide by Molina?s policies ? Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) ? Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Required Education: High School diploma or equivalent GED
Required Experience: ? 5-7 years healthcare experience, Medicare and Medicaid a plus. ? 5-7 years Claims Operations or application vendor experience. ? 5-7 years experience interpreting benefits, contracts and other business requirements. ? 5-7 years experience with medical coding initiatives and coding guidelines.