Senior Business Consultant jobs at Presbyterian - 45 jobs

Business Analytic Consultant - Remote Eligible
Presbyterian Hospital 4.8
Senior business consultant job at Presbyterian
9521 San Mateo NE , Albuquerque, New Mexico 87113-2237, United States of America Compensation Pay Range: Minimum Offer $: 83366.4 is up to $: 127275.2 Now hiring a Business Analytic Consultant - Remote Eligible Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Business Analytics Consultant to contribute to portfolio of reporting/analytics solutions across the business units in the analytics organization. Identify business issues/problems, form hypotheses, plan and conduct interviews, whiteboard sessions & perform reporting/analysis to synthesize conclusions, transform them into recommendations and develop a solution. Participate in small cross functional team to implement, test and deploy the approved reporting/analytics solution in response to the business (clinical/operational/financial) needs. Identify reporting/analytics improvement opportunities and provide proactive, consultative strategic solutions. Responsible for coordinating various reporting/analytics initiatives with end business users. Support reporting/analytics projects prioritization and planning as well as cconduct due diligence concerning business implications of planned solutions. Type of Opportunity: Full time Job Exempt: Yes Job is based : Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America) Responsibilities: Preferred Skills and Experience: Working knowledge of EPIC workflows and database reporting structures (Clarity, Caboodle, Slicer Dicer, Databricks, etc.) Experience providing analytical insights for Hospital Inpatient/Outpatient and Emergency department patient care. Understanding of nursing and provider staffing for hospitals and emergency departments a plus Ability to translate data into actionable insights through clear data storytelling to improve patient flow Experience managing and monitoring demand requests using intake tools (e.g., ServiceNow) Strong organizational skills with the ability to manage multiple tasks, milestones, deadlines, and projects simultaneously Proficient in creating MS SQL code to retrieve and analyze data Experience using SAS Enterprise Guide preferred Working knowledge of business intelligence tools such as Tableau, Amazon QuickSight, and Business Objects Types of projects they will work on: Facilitate analytics requests from business teams to track performance on targeted initiatives and milestones Partner with business and operational teams to provide analytics supporting patient flow improvements Consult on and manage the development of dashboards for business stakeholders Translate raw data into actionable insights using clear data storytelling techniques Capture and articulate actionable insights using clear data storytelling techniques to business stakeholders Serve as a project or team lead for initiatives involving cross‑functional partners Hybrid: In office expected for individuals within 60 Miles of Albuquerque every Tues, Wed, Thurs Remote: Open to remote applicants in the United States, except for the following states: California, Illinois, North Dakota, New York, Ohio, Washington and Wyoming. Qualifications: Bachelors degree in a quantitative, business, or healthcare related subject. A Masters degree is highly preferred. Three or more years of combined experience in business intelligence, reporting and analytics preferably in a healthcare setting. Demonstrated project management skills as well as the ability to efficiently work with teams and resources. Experience working on complex analytical projects with diverse teams and developing data driven and outcome based initiatives to improve business decision making and operational efficiencies. Knowledge of health plan and delivery system operations, health care informatics, and healthcare benefits and terminology (e.g., care management). Understanding of operations in the Health Care industry and a strong acumen of business processes, including operations, delivery models and revenue models a plus. Understanding of program evaluation life cycle, predictive modeling, data mining, and clinical best practices preferred. Content knowledge related to program outcomes evaluation, BI tools (e.g., BO), data visualizations tools (e.g., Tableau), statistical software such as SAS and Modeling techniques, as well as general health service research and outcomes reporting/analytics. Working knowledge of healthcare industry and healthcare information standards such as HL7, LOINC, FHIR, ICD 9/10 and CPT codes, industry standard groupers (e.g., ETGs, DRGs, DCGs, etc.) as well as of health care delivery system processes. Excellent written and oral communications is a MUST. All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services
$83k-110k yearly est. Auto-Apply 4d ago

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Improvement Optimization Consultant Intermediate (Work from Home United States)
Geisinger Medical Center 4.7
Remote
Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes Facilitates multidisciplinary improvement teams, gathers data, performs research, completes analytics and compiles best practice information while providing project management for operational and clinical staff to achieve transformational strategic and tactical project results. Focused efforts within a single system platform, to achieve improved patient experience, safety, staff satisfaction, quality, timeliness and efficiency improvement while achieving a favorable value. Job Duties: Manages work to meet project milestones through application of project management discipline, consistent follow through, relationship management and creative organizational problem solving. Consistently achieves project outcomes at target goals and reaches stretch goals frequently through consistent follow-through, creative problem solving, removing barriers and tenacious focus on results. Hardwires process improvements and embeds process and outcome metrics in improvement initiatives that: draw data electronically from clinical and administrative records; are presented in easy to understand graphic format and have sufficient detail to identify specific sources of actionable opportunity. Identifies and analyzes performance opportunities in operational, clinical, sales, human resources, marketing, information technology and financial processes through the use of administrative and clinical systems. Identifies best practices and evaluates performance against evidence and research. Streamlines clinical and operational workflows to support improved outcomes and efficiency. Assesses the local stakeholder environment and works with project sponsors and leaders to build the support and will to address improvement opportunities among line staff, providers and leaders. Manages relationships to achieve transformational change with staff, providers and leaders. Uses analytic, experiential and subjective assessment skills to identify substantial performance improvement opportunities. Documents work products and methodologies to enable analysis and knowledge transfer. Design and develops project specific education plans and content. Conducts training sessions for staff, providers and leaders. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Position Details: Education: Bachelor's Degree-Healthcare Related Degree (Required), Master's Degree-Healthcare Related Degree (Preferred) Experience: Minimum of 3 years-Related work experience (Required) Certification(s) and License(s): Skills: Builds Relationships, Critical Thinking, Leads Others, Waterfall Model, Working Independently OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
$73k-95k yearly est. Auto-Apply 17d ago
Business Architect Senior (UiPath Automation)
Geisinger Medical Center 4.7
Remote
Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes The Business Architect Senior serves as a primary Liaison between the business community and the Intelligent Automation Hub within Innovations. Works on projects of varying of varying size and scope including specific Line of Business processes and re-engineering. Works on multiple projects concurrently, to correctly understand and accurately document workflow, processes, business rules, data, systems, and other required for a clear picture of the business. Coordinates the development, documentation, analysis and review of business requirements and processes. In conjunction with users, re-engineers and redesigns a more effective and efficient business. Aligns strategic goals and objectives with decisions regarding products and services; partners and suppliers; organization; capabilities; and key business and IT initiatives. Job Duties: Provides operational accountability and administrative leadership for the assigned areas. Serves as department liaison with outside constituents and as an active participant in assigned management forums. Serves as a SME for directed specialty automation area (Examples could be OCR, AI, etc) Assists IAH Director with establishing key performance indicators and preparing reports for Leadership. Builds trusted relationships and strategic partnerships with business stakeholder to prioritize investment areas for technology and drive innovation Designs and conducts workshops with key stakeholders to educate on automation technology, in addition to understanding how automation can be applied to the business Implements activities and tools that consistently focus staff on key performance indicators and fosters continuous improvements. Facilitates active engagement and communication with department staff via formal meetings and informal interactions. Assesses staff and facilitates skill development for all personnel as needed. Collaborates with UiPath team and prepares training plan for IAH team. Mentors Business Architects-associates Consults on Institute-facing projects and maintains knowledge of their progress Displays customer and patient first mentality Develops a business architecture strategy based on a situational awareness of various business scenarios and motivations. Captures the tactical and strategic enterprise goals that provide traceability through the organization and are mapped to metrics that provide ongoing governance. Describes the primary business functions of the enterprise and distinguish between customer-facing, supplier-related, business execution and business management functions. Defines the set of strategic, core and support processes that transcend functional and organizational boundaries; identify and describe external entities such as customers, suppliers, and external systems that interact with the business; and describe which people, resources and controls are involved in the processes. Captures the relationships among roles, capabilities and business units, the decomposition of those business units into subunits, and the internal or external management of those units. Assists in the analysis, design, and development of a roadmap and implementation plan based upon a current vs. future state in a cohesive architecture viewpoint Supports and participates in developing policies, standards, guidelines and procedures. Analyzes the current architecture to identify weaknesses and develop opportunities for improvements. Provides strategic consultation to clients and IT teams. Advises on options, risks, costs versus benefits, system impacts, and technology priorities. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Relevant experience may be a combination of related work experience and/or degree obtained (Associate's Degree = 2 years relevant experience; Bachelor's Degree = 4 years relevant experience; Master's Degree = 6 years). Position Details: Education: High School Diploma or Equivalent (GED)- (Required) Experience: Minimum of 12 years-Relevant experience* (Required) Certification(s) and License(s): Skills: Organizing, Teamwork, Working Independently OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
$90k-116k yearly est. Auto-Apply 60d+ ago
Improvement Optimization Consultant Intermediate (Work from Home United States)
Geisinger 4.7
Danville, PA jobs
Facilitates multidisciplinary improvement teams, gathers data, performs research, completes analytics and compiles best practice information while providing project management for operational and clinical staff to achieve transformational strategic and tactical project results. Focused efforts within a single system platform, to achieve improved patient experience, safety, staff satisfaction, quality, timeliness and efficiency improvement while achieving a favorable value. Job Duties + Manages work to meet project milestones through application of project management discipline, consistent follow through, relationship management and creative organizational problem solving. + Consistently achieves project outcomes at target goals and reaches stretch goals frequently through consistent follow-through, creative problem solving, removing barriers and tenacious focus on results. + Hardwires process improvements and embeds process and outcome metrics in improvement initiatives that: draw data electronically from clinical and administrative records; are presented in easy to understand graphic format and have sufficient detail to identify specific sources of actionable opportunity. + Identifies and analyzes performance opportunities in operational, clinical, sales, human resources, marketing, information technology and financial processes through the use of administrative and clinical systems. + Identifies best practices and evaluates performance against evidence and research. + Streamlines clinical and operational workflows to support improved outcomes and efficiency. + Assesses the local stakeholder environment and works with project sponsors and leaders to build the support and will to address improvement opportunities among line staff, providers and leaders. + Manages relationships to achieve transformational change with staff, providers and leaders. + Uses analytic, experiential and subjective assessment skills to identify substantial performance improvement opportunities. + Documents work products and methodologies to enable analysis and knowledge transfer. + Design and develops project specific education plans and content. + Conducts training sessions for staff, providers and leaders. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Position Details Education Bachelor's Degree-Healthcare Related Degree (Required), Master's Degree-Healthcare Related Degree (Preferred) Experience Minimum of 3 years-Related work experience (Required) Certification(s) and License(s) OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
$69k-90k yearly est. 15d ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Santa Fe, NM jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. **Knowledge/Skills/Abilities** - Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. - Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. - Assess risk and resolve conflict through mediation. - Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. - Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. - Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. - Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). - Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. - Assist management in preparing for difficult employee conversations, including creating talking points. - Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. - Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. - Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. - Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . **Job Qualifications** **Required Education** Bachelor's Degree or equivalent experience **Required Experience** 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. **Preferred Education** Master's Degree or J.D. 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: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-155.5k yearly 4d ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Albuquerque, NM jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. **Knowledge/Skills/Abilities** - Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. - Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. - Assess risk and resolve conflict through mediation. - Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. - Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. - Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. - Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). - Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. - Assist management in preparing for difficult employee conversations, including creating talking points. - Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. - Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. - Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. - Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . **Job Qualifications** **Required Education** Bachelor's Degree or equivalent experience **Required Experience** 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. **Preferred Education** Master's Degree or J.D. 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: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-155.5k yearly 4d ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Houston, TX jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. **Knowledge/Skills/Abilities** - Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. - Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. - Assess risk and resolve conflict through mediation. - Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. - Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. - Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. - Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). - Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. - Assist management in preparing for difficult employee conversations, including creating talking points. - Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. - Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. - Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. - Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . **Job Qualifications** **Required Education** Bachelor's Degree or equivalent experience **Required Experience** 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. **Preferred Education** Master's Degree or J.D. 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: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-155.5k yearly 4d ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Long Beach, CA jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. Knowledge/Skills/Abilities • Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. • Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. • Assess risk and resolve conflict through mediation. • Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. • Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. • Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. • Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). • Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. • Assist management in preparing for difficult employee conversations, including creating talking points. • Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. • Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. • Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. • Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . Job Qualifications Required Education Bachelor's Degree or equivalent experience Required Experience 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. Preferred Education Master's Degree or J.D. 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.
$110k-143k yearly est. Auto-Apply 6d ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Rio Rancho, NM jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. **Knowledge/Skills/Abilities** - Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. - Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. - Assess risk and resolve conflict through mediation. - Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. - Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. - Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. - Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). - Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. - Assist management in preparing for difficult employee conversations, including creating talking points. - Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. - Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. - Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. - Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . **Job Qualifications** **Required Education** Bachelor's Degree or equivalent experience **Required Experience** 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. **Preferred Education** Master's Degree or J.D. 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: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-155.5k yearly 4d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Santa Fe, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 32d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Santa Fe, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 60d+ ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Albuquerque, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 32d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Albuquerque, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 60d+ ago
Senior Consultant, Employee Relations (Remote)
Molina Healthcare 4.4
Las Cruces, NM jobs
The Sr. ER Consultant is generally responsible for the following: Mitigating risk for the organization and creating capacity for people leaders in counseling and guiding them through complex employee issues; and Balancing both the need to mitigate risk and to positively impact the employee experience in addressing employee concerns and reaching fair and equitable solutions. Areas of primary responsibility include investigations, corrective action, coaching & counseling for people leaders, leaves of absence, accommodations, with responsibility to support and have the capability to handle reductions in force, EEOC responses and policy interpretation. Core competencies include ability to write and speak concisely, compassionately, and persuasively, strong listening skills, as well as conflict resolution, negotiation and mediation skills. **Knowledge/Skills/Abilities** - Identify and mitigate risk for the organization by managing employee relations issues and ensuring adherence to policies, practices as well as Molina's mission, vision and values. - Utilize exceptional written communication skills to prepare appropriate documentation for each matter with discoverability in mind. - Assess risk and resolve conflict through mediation. - Track appropriate level of detail by case to ensure ability to identify trends through reporting and address recurring risk. - Promote positive work environment & employee experience by yielding fair and equitable solutions for employees. - Conduct investigations into alleged misconduct and workplace incivility, applying the appropriate amount of time and diligence based on the nature of the case and facts presented. - Utilize the Employee Engagement Survey results to create solutions and a better employee experience within client group(s). - Assist management in addressing employee issues, including but not limited to, corrective action, employee coaching, leaves of absence, accommodations, HR policy adherence. - Assist management in preparing for difficult employee conversations, including creating talking points. - Provides an overall strategic view of the employee relations issues facing management and conducts trend analysis and creates training to get in front of issues. - Provide efficient, consistent and prompt consultative services, thereby creating capacity for people leaders. - Mentors and leads Employee Relations Consultants by providing expertise and guidance on employee relations issues. - Takes the lead on complex employee relations projects or initiatives. Partners with HRBP's, Legal, Compliance and other key stakeholders as appropriate. . **Job Qualifications** **Required Education** Bachelor's Degree or equivalent experience **Required Experience** 5-7 years in Human Resources, counseling, social work, law, or reasonably comparable field. **Preferred Education** Master's Degree or J.D. 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: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
$80.2k-155.5k yearly 4d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Rio Rancho, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 32d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Rio Rancho, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 60d+ ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Roswell, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 32d ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Roswell, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Recoveries & Disputes * Review and validate provider complaints and payment disputes, ensuring accurate and timely resolution in line with policy and contractual guidelines. * Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. * Evaluate root cause for the disputes and recommend improvements to reduce claim errors and prevent improper payments. * Provide actionable insights and recommendations to leadership to drive continuous improvement. Skills & Competencies * Proven experience handling provider disputes, appeals, and overpayment recoveries in a managed care or payer environment. * In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. * Strong understanding of claim system configurations, payment policies, and audit processes. * Exceptional analytical, problem-solving, and documentation skills. * Ability to translate complex business problems into clear system requirements and process improvements. * Proficiency in Excel * Knowledge in QNXT preferred * Strong communication and stakeholder management skills with ability to influence across teams. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 60d+ ago
Senior Analyst, Business
Molina Healthcare Inc. 4.4
Las Cruces, NM jobs
Provides senior level support for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. JOB DUTIES * Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to regulatory baseline requirements and any health plan/product team developed requirements. * Monitors regulatory sources to ensure all updates are aligned as well as work with operational leaders within the business to provide recommendations for process improvements and opportunities for cost savings. * Leads coordinated development and ongoing management /interpretation review process, committee structure and timing with key partner organizations. Interpret customer business needs and translate them into application and operational requirements. * Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. * Where applicable, codifies the requirements for system configuration alignment and interpretation. * Provides support for requirement interpretation inconsistencies and complaints. * Assists with the development of requirement solution standards and best practices while suggesting improvement processes to consistently apply requirements across states and products where possible. * Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. * Coordinates with relevant teams for analysis, impact and implementation of changes that impact the product. * Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. KNOWLEDGE/SKILLS/ABILITIES * Maintains relationships with Health Plans/Product Team and Corporate Operations to ensure all end-to-end business requirements have been documented and interpretation are agreed on and clear for solutioning. * Ability to meet aggressive timelines and balance multiple lines of business, states, and requirement areas. * Strong interpersonal and (oral and written) communication skills and ability to communicate with those in all positions of the company. * Ability to concisely synthesize large and complex requirements. * Ability to organize and maintain regulatory data including real-time policy changes. * Self-motivated and ability to take initiative, identify, communicate, and resolve potential problems. * Ability to work independently in a remote environment. * Ability to work with those in other time zones than your own. JOB QUALIFICATIONS Required Qualifications * At least 4 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. * Policy/government legislative review knowledge * Strong analytical and problem-solving skills * Familiarity with administration systems * Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams * Previous success in a dynamic and autonomous work environment Preferred Qualifications * Project implementation experience * Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). * Medical Coding certification. 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. Pay Range: $80,168 - $128,519 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$80.2k-128.5k yearly 32d ago
Senior Business System Analyst - Remote Eligible
Presbyterian Hospital 4.8
Senior business consultant job at Presbyterian
9521 San Mateo NE , Albuquerque, New Mexico 87113-2237, United States of America Compensation Pay Range: Minimum Offer $: 72134.4 is up to $: 110136 Now hiring a Senior Business System Analyst - Remote Eligible Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Business System Analyst to formulate and define systems scope and objectives based on both user needs and a good understanding of applicable business systems and industry requirements. Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time, and form of desired results. Type of Opportunity: Full time Job Exempt: Yes Job is based : Reverend Hugh Cooper Administrative Center Work Shift: Weekday Schedule Monday-Friday (United States of America) Responsibilities: This position includes analysis of business and user needs, documentation of requirements, and translation into proper system requirement specifications. Competent to work at the highest level of most phases of systems analysis while considering the business implications of the application of technology to the current and future business environment Hybrid: In office expected for individuals within 60 Miles of Albuquerque every Tues, Wed, Thurs Remote: Open to remote applicants in the United States, except for the following states: California, Illinois, North Dakota, New York, Ohio, Washington and Wyoming Some key responsibilities include: Acts as primary liaison between the application team and the user community, responsible for facilitating communications, coordinating system enhancements, and providing production support. Works with user community to define business requirements in sufficient detail that systems configuration, development/enhancement, and/or operations activities can be pursued. Guides user community to define business use cases in sufficient detail that subsequent quality assurance efforts can guarantee system changes/enhancements satisfy the business requirements.. Guides internal quality assurance efforts to verify functional system behavior. Guides the user community to coordinate quality assurance and acceptance testing efforts to verify functional system behavior. Guides other staff to educate/train members of the user community in proper and effective use of the application system. Provides implementation support for software components of moderate to high complexity Provides production support for software components of moderate to high complexity Qualifications: Bachelor s degree in related technical/business area plus 4 years of IT or business experience. 6 years of additional experience can be substituted in lieu of degree. Advanced knowledge of Systems Analysis with focus on customer requirements and concepts of the software development lifecycle Preferred Qualifications: Experience in healthcare (Health Plan) domain Experience with writing SQL queries, research issue and analyze data Experience in Health Plan EDI mapping and processing include but not limited to 278/837/834/820/835. Experience with writing Business Requirements Documents and EDI Guides. Multi Tasker, Detail Oriented, Able to adapt to new Systems easily, Documentation, Good with EXCEL All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services
$89k-111k yearly est. Auto-Apply 2d ago