Lead Analyst, Claims / Regulatory Compliance

Molina Healthcare; Miami (FL); On-site; USD 77,000 - 110,000; Full time

Job summary

A leading healthcare provider in Miami is seeking a professional responsible for managing and maintaining claims databases. The ideal candidate has extensive experience in problem-solving with Health Plans, documentation, and medical coding. Offering a competitive salary range of $77,969 - $110,000 annually, this role requires a Bachelor's degree and 7-9 years of experience in a related field.

Benefits

Competitive benefits and compensation package

Qualifications

• 7-9 years of related experience required.
• 10+ years of experience preferred.
• Experience with Medicare, Medicaid and Marketplace is required.

Responsibilities

• Implement and maintain claims databases.
• Synchronize data among operational and claims systems.
• Train staff on configuration functionality.
• Create management reporting tools for configuration updates.

Skills

Researching

Documentation

Problem-solving

Negotiation

Medical coding

Communication

Education

Bachelor's Degree

Graduate Degree

Job description

JOB DESCRIPTION

Job Summary

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.

KNOWLEDGE/SKILLS/ABILITIES

• Trains staff on configuration functionality, enhancements, and updates.

• Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.

• Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.

• Creates management reporting tools to enhance communication on configurations updates and initiatives.

• Negotiates expected completion dates with Health Plans.

• Extensive experience on researching, presenting and documenting is required,

• Experience with Medicare, Medicaid and Marketplace is required.

• Medical coding experience is highly preferred.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Education

Graduate Degree or equivalent experience

Preferred Experience

10+ years

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: $77,969 - $110,000 / ANNUAL

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