QNXT Configuration Specialist - Sr

Molina Healthcare

About The Position

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. Knowledge/Skills/Abilities Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. Coordinate, facilitate and document audit walkthroughs. Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. Ability to write SQL queries Experience with QNXT configuration Experience with troubleshooting and analyzing issues. Experience working in a Medicare environment is highly preferred. Claims adjudication experience is highly preferred.

Requirements

Associate's Degree or two years of equivalent experience
Four years proven analytical experience within an operations or process-focused environment.
Analytical experience within managed care operations.
Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions.

Nice To Haves

Bachelor's Degree
Six years proven analytical experience within an operations or process-focused environment.
Previous audit and/or oversight experience.
Experience working in a Medicare environment is highly preferred.
Claims adjudication experience is highly preferred.

Responsibilities

Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.
Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation.
Use analytical skills to identify variances.
Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
Summarize and document assessment outcomes and recommendations.
Ensure that they are appropriately communicated (written and verbal) to process owners and management.
Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.
Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.
Coordinate, facilitate and document audit walkthroughs.
Research, collect or generate requested documentation.
Provide timely and accurate responses, both written and verbal.
Research and respond to clarifying questions submitted by internal and external auditors.
Work in partnership with other functional areas as needed.
Ability to write SQL queries
Experience with QNXT configuration
Experience with troubleshooting and analyzing issues.