Job Information
Molina Healthcare Business Analyst (Payment Integrity pre-pay) in Iowa
JOB DESCRIPTION
Job Summary
Analyzes complex business problems and issues within Payment Integrity Pre-Pay using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Works with CPT, HCPCS, ICD-9 and ICD-10 coding systems within Medicare & Medicaid regulations. Will support stakeholders with claims processing, reimbursement concepts, and identifying trends, discrepancies and opportunities for cost avoidance.
KNOWLEDGE/SKILLS/ABILITIES
Provides analytical, problem solving foundation including: definition and documentation, specifications.
Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert.
Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements.
Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met
Prepares high level user documentation and training materials as needed.
JOB QUALIFICATIONS
Required Education
Associate's Degree or equivalent combination of education and experience
Required Experience
3-5 Years of business analysis
4+ years managed care experience
Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.
Preferred Education
Bachelor's Degree or equivalent combination of education and experience
Preferred Experience
Understanding Medicare and Medicaid regulations
Understanding claims processing and reimbursement concepts
Proficiency in analyzing healthcare data to identify trends, discrepancies, and opportunities for cost avoidance
Strong analytical thinking skills
Excellent verbal and written communication skills
The ability to work effectively with cross-functional teams and establish credibility
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: $26.19 - $51.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.