QNXT Configuration Specialist - Sr

Job Description Job Summary

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.

• 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.

Associate's Degree or two years of equivalent experience

• Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations:

• 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.

Bachelor's Degree

• Six years proven analytical experience within an operations or process-focused environment.

• Previous audit and/or oversight experience.

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.