Claims Research/ Data Analyst Sr (EDI/Edifecs)

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely production review of issues reported within our claims intake and processing ecosystem (QNXT, Edifecs, etc.).  Gains understanding of solution functionality through documentation review, identify root cause, validate root cause and extrapolate potential impact of issue.  Validates data received on claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to identify defects in the solution or configuration during warranty period.  

 

KNOWLEDGE/SKILLS/ABILITIES

• Knowledge of healthcare claims and claim processing from receipt through encounter submission
• Knowledge of configuration in QNXT preferred
• Knowledge of claim pricing preferred
• Strong SQL knowledge preferred
• Edifecs knowledge preferred
• Understanding of Healthcare EDI Claims transactions preferred
• Understanding of complex claim payment methodologies
• Understanding of configuration solutions preferred
• Ability to use critical thinking to analyze claim processing issues
• Ability to work with internal and external stakeholders to gain solution knowledge.
• Possesses or Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment with limited training and documentation.
• Complex projects with some mentoring
• Moderate to Simple projects without mentoring
• Researches issues and sets up proof of concept tests.

 

JOB QUALIFICATIONS

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

3-4 Years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

5-6 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.