Molina Healthcare - Florence, KY
posted 3 months ago
The position is responsible for the accurate and timely production review of issues reported within the claims intake and processing ecosystem, which includes systems such as QNXT and Edifecs. The individual in this role will gain a comprehensive understanding of the solution functionality through thorough documentation review. They will identify the root cause of issues, validate these causes, and extrapolate the potential impact of the identified issues on the claims processing and payment systems. Additionally, the role involves validating data received on claims to identify any billing issues that may affect claims processing and payment outcomes. The position also requires monitoring new solutions that have been implemented to identify any defects in the solution or configuration during the warranty period. This entails a deep understanding of the Molina claims life cycle and all processes that affect claims payment, which the individual will develop with limited training and documentation. The role may involve working on complex projects with some mentoring, as well as moderate to simple projects without mentoring. The individual will be expected to research issues and set up proof of concept tests to ensure the integrity and efficiency of the claims processing system.