JOB DESCRIPTION

Job Summary

Ensure the accuracy and completeness of provider data change requests by submitting them according to market-specific business rules, facilitating the accurate and timely payment of claims. Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

• Manage the provider roster process.

• Resolve “fall out” Provider Data and Provider Master File with a focus on claim accuracy

• Represent the HP for all internal Provider Data Management related request.

• Provide HP Oversight of the Provider Master File and Provider Data accuracy

• Partner with VP of Network to resolve provider data issues

• Outreach to Providers as needed to educate and resolve provider data issues.

• Interpret customer business needs and translate them into application and operational requirements

• Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.

• Work with operational leaders within the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements.

• Create Business Requirements Documents, Test Plans, Requirements Traceability Matrix, User Training materials and other related documentations.

• Actively participates in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

• 5-7 years of business analysis experience,

• 6+ years managed care experience.

• Demonstrates proficiency 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

• 3-5 years of formal training in Project Management

• Experience working with complex, often highly technical teams

• 3+ years experience working with Provider Data changes within an MCO highly preferred

Preferred License, Certification, Association

Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred

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: $49,430.25 - $107,098.87 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.