Job Description

Job Summary: Join our team as a Senior Business Analyst specializing in Medicaid Claims Payments. In this dynamic role, you will support the Senior Leadership Team by providing expert guidance on intricate claims-related issues and service recovery initiatives. Your analytical skills will be crucial in solving complex business problems using data from various sources, equipping decision-makers with vital insights. You will identify trends and patterns within datasets, forecast outcomes, and develop strategic recommendations.

Key Responsibilities:

• Analyze complex business problems and provide insight into decision-making.
• Create reports and specifications based on business needs and available data.
• Collaborate with clients to customize analysis and reporting to their specific requirements.
• Engage in management reviews, presenting and interpreting analytical results, and making actionable recommendations.
• Gather requirements through interviews, workshops, and documentation analysis; translate business needs into requirements effectively.
• Work closely with operational leaders to identify opportunities for process improvements and enhance medical cost savings or revenue.
• Develop Business Requirements Documents, Test Plans, User Training materials, and other essential documentation.
• Support all stages of project development, including research, design, and implementation.
• Provide Level II claims support to internal teams and directly with providers as needed.
• Monitor and resolve work queues related to timely claims payments and encounters processing.

Qualifications:

• Required Education: Bachelor's Degree or equivalent experience.
• Required Experience: 5-7 years in business analysis with a focus on claims payment accuracy; 6+ years in managed care (preferably in Payer Claims environment).
• Proficiency in claims processing concepts including Provider Data, Claims Configuration, and Claims Adjudication.
• Preferred Experience: 3-5 years troubleshooting claims escalations; direct provider interaction experience.
• Experience working with technical teams and familiarity with Medicaid and Medicare regulations.
• Familiarity with QNXT, coding, SQL, and Salesforce.

Molina Healthcare offers a competitive benefits and compensation package. We are an Equal Opportunity Employer (EOE) M/F/D/V.

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