Job Description JOB DESCRIPTION For this position, Enrollment experience is a must have. Ideal candidate will have experience working at an MCO on the Enrollment operations team or at a health plan. Experience with 834 EDI file and implementing Medicaid product in a new market. Job Summary Responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. These positions' primary focus is project/program management. Job Duties <ul> <li>Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.</li> <li>Plans and directs schedules as well as project budgets.</li> <li>Monitors the project from inception through delivery.</li> <li>May engage and oversee the work of external vendors.</li> <li>Focuses on process improvement, organizational change management, program management and other processes relative to the business.</li> <li>Leads and manages team in planning and executing business programs.</li> <li>Serves as the subject matter expert in the functional area and leads programs to meet critical needs.</li> <li>Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.</li> <li>Works with operational leaders within the business to provide recommendations on opportunities for process improvements.</li> <li>Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.</li> <li>Generate and distribute standard reports on schedule</li></ul> JOB QUALIFICATIONS REQUIRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience. REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: <ul> <li>3-5 years of Program and/or Project management experience.</li> <li>Operational Process Improvement experience.</li> <li>Healthcare experience.</li> <li>Experience with Microsoft Project and Visio.</li> <li>Excellent presentation and communication skills.</li> <li>Experience partnering with different levels of leadership across the organization.</li></ul> PREFERRED EDUCATION: Graduate Degree or equivalent combination of education and experience. PREFERRED EXPERIENCE: •5-7 years of Program and/or Project management experience. •Managed Care experience. •Experience working in a cross functional highly matrixed organization. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: •PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired. 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.

Job Description JOB DESCRIPTION ****Employee for this role will work standard EST business hours****** Job Summary Designs and implements processes and solutions associated with a wide variety of healthcare data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production, and communicates results to a broad range of audiences. Effectively uses current and emerging technologies. KNOWLEDGE/SKILLS/ABILITIES <ul> <li>Extracts and compiles various sources of information and large data sets from various systems to identify and analyze outliers.</li> <li>Sets up process for monitoring, tracking, and trending department data.</li> <li>Prepares any state mandated reports and analysis.</li> <li>Works with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes.</li> <li>Implements and uses the analytics software and systems to support the departments goals.</li></ul> JOB QUALIFICATIONS Required Education Associate's Degree or equivalent combination of education and experience Required Experience 1+ years Healthcare Analytics Preferred Education Bachelor's Degree or equivalent combination of education and experience Preferred Experience 3+ years Healthcare Data Analytics 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.

Job Description Job Description Job Summary Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints, legal requests, or identified internally by Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments, develops and tracks remediation plans, and monitors claims reprocessing through resolution. Interprets and presents in-depth analysis of findings and results to leadership and respective operations teams. Responsible for ensuring the projects are completed accurately and timely. Job Duties <ul> <li>Uses analytical skills to conducts research and analysis for issues, requests, and inquiries of high priority claims projects</li> <li>Assists with reducing re-work by identifying and remediating claims processing issues</li> <li>Locate and interpret regulatory and contractual requirements</li> <li>Tailors existing reports or available data to meet the needs of the claims project</li> <li>Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing errors</li> <li>Applies claims processing and technical knowledge to appropriately define a path for short/long term systematic or operational fixes</li> <li>Helps to improve overall claims performance to ensure claims are processed accurately and timely</li> <li>Identifies claims requiring reprocessing or re-adjudication in a timely manner to ensure compliance</li> <li>Works closely with external departments to define claims requirements</li> <li>Recommends updates to Claims SOP's and Job Aid's to increase the quality and efficiency of claims processing</li> <li>Fields claims questions from Molina Operations teams</li> <li>Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, overall progress, and status of impacted claims</li> <li>Provides excellent customer services to our internal operations teams concerning claims projects</li> <li>Appropriately convey information and tailor communication based on the targeted audience</li> <li>Provides sufficient claims information to our internal operations teams that must communicate externally to provider or members</li> <li>Able to work in a project team setting while also able to complete tasks individually within the provided timeline or as needed, accelerated timeline to minimize provider/member impacts and/or maintain compliance</li> <li>Manages work assignments and prioritization appropriately</li></ul> Job Qualifications REQUIRED EDUCATION: Associate's degree or equivalent combination of education and experience REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: <ul> <li>1-3 years claims analysis experience</li> <li>5+ years medical claims processing experience across multiple states, markets, and claim types</li> <li>Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas</li> <li>Knowledge and experience using Excel</li></ul> PREFERRED EDUCATION: Bachelor's Degree or equivalent combination of education and experience PREFERRED EXPERIENCE: <ul> <li>1-3 years claims analysis</li> <li>6+ years medical claims processing experience</li> <li>Project management</li> <li>Expert in Excel and PowerPoint</li></ul> PHYSICAL DEMANDS: Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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.

Molina Healthcare Jobs

Medicaid Product Manager Enrollment
May 8, 2024

Healthcare Data Analyst Est Business Hours
May 8, 2024

Claims Research Analyst Remote
May 4, 2024

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Molina Healthcare Jobs

Medicaid Product Manager EnrollmentMay 8, 2024

Healthcare Data Analyst Est Business HoursMay 8, 2024

Claims Research Analyst RemoteMay 4, 2024

Quick filters

Top companies

Medicaid Product Manager Enrollment
May 8, 2024

Healthcare Data Analyst Est Business Hours
May 8, 2024

Claims Research Analyst Remote
May 4, 2024