Lead Analyst, Configuration Oversight (COB/ Audit Quality & Accuracy/ Claims Configuration)

About the role

**KNOWLEDGE, SKILLS & ABILITIES** (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job):

+ Trains audit staff on configuration functionality, enhancements and updates.

+ Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state/federal requirements.

+ Creates management reporting tools to enhance audit communication on configurations accuracy results and/or audit findings

+ Writes complex ad-hoc report

+ Interprets and validates accuracy of complex MRDT and other configuration update scripts

+ Assists manager in establishing standards, guidelines, and best practices for the audit team

+ Interprets and validates accuracy of complex reports and automated configuration processes/solutions

+ Assist manager in establishing peer review standards and methodolog

+ Leads peer reviews

+ Research and review new audit tools and techniques and provide recommendations to management

+ Validates accuracy of new complex configuration processes/solutions

+ Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages

+ Interprets complex business problems and technical issues

+ Effectively communicates audit findings and/or outcomes through review meetings, written communications, and, workflow diagrams.

+ Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle

+ Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment

+ Develops and maintain standards and best practices for the team

+ Mentors junior auditors

+ Participates in or leads project meetings

+ Understands QNXT, AutoQ, and MCG functionality and schema

+ Writes Requirements for BRDs/FRDs and Reports without needing mentoring

+ Suggests schema/solution. Works with technical resource to determine best solution.

+ Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc.

+ Researches complex issues\

+ Acts as a team lead, assigning and prioritizing work for other team members as needed

**JOB FUNCTION:**

+ Responsible for accurate and timely auditing of critical information on claims databases.

+ Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database.

+ Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

+ Responsible for work load assignment to auditors.

+ Train and coach new employees .

+ Provide clear and concise results and comments to leaders about focal and and random audits across all states.

+ Monitors and controls workflow.

+ Ensures that audits are conducted in a timely fashion and in accordance with unit standards.

**REQUIRED EDUCATION:**

Bachelor’s Degree or equivalent combination of education and experience

**REQUIRED EXPERIENCE:**

5-6 Years

**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:**

**PREFERRED EDUCATION:**

Graduate Degree or equivalent experience

**PREFERRED EXPERIENCE:**

7+ Years

**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:**

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

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

Pay Range: $59,810.6 - $129,589.63 / ANNUAL

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

Posting text as published by Molina Healthcare.

The evidence behind this listing

Workplace

Remote Matched in posting text

Seniority

senior From the job title

Employment type

Not established

Location as listed

Virtual, USA

Pay and work authorization

Stated pay

$59.8k–129.6k/yr AI reading of the posting

Visa sponsorship

Not stated

Security clearance

Not established

Citizenship

Not established