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

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

• 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.

Bachelor’s Degree or equivalent combination of education and experience

Graduate Degree or equivalent experience

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