Molina Healthcare - Owensboro, 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 workflow. Additionally, the role involves validating data received on claims to identify any billing issues that could affect claims processing and payment. 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 can be achieved with limited training and documentation. The role may involve working on complex projects with some mentoring, as well as moderate to simple projects that may not require mentoring. The individual will also be responsible for researching issues and setting up proof of concept tests to ensure the integrity and efficiency of the claims processing system.