Senior business analyst jobs in Grand Island, NE

Our ideal candidate would have a positive attitude, good work attendance and be someone open to overtime opportunities. Cooperative Producers, Inc. (CPI) offers a diverse range of employment opportunities that span a wide variety of fields. We continuously seek enthusiastic and qualified individuals who can help contribute to the growth and success of our cooperative. CPI is seeking a dedicated Senior Custom Crop Applicator to join our expanding team. We deeply value our employees' contributions and are committed to their professional development, engagement, and success. We recruit and retain the best people to continually deliver exceptional value. CPI is proudly committed to our "Making Local Matter" initiative by forging enduring partnerships with local farmers and actively supporting the communities of Northern Kansas and Central Nebraska. As an employee of CPI, you will have the opportunity to make a positive impact on your community and support CPI's mission of making local matter. What the job is: CPI is looking for someone who likes to work outside and enjoys working independently. This person should have a solid understanding of product blends and custom applied fertilizers and chemicals based on recommendations and label directions applied to fields using a sprayer or a floater. Experience running a liquid sprayer is a must. This person should also have experience and knowledge in applying dry fertilizers as well. Punctuality and consistent attendance to meet business demands is required and extended hours will be expected in season including nights and weekends. CPI is a safety minded company thus such policies must be followed. A Senior Custom Crop Applicator will also utilize and operate variable rate technology, GPS guidance systems and application software on equipment. In addition, this person will be responsible for loads and unloads of inbound and outbound inventory and assist the Grain and Agronomy Operations at times. * High School Diploma and/or GED and/or training is required. * A minimum of two years' experience in custom liquid application is required. * A valid Driver's License and Commercial Applicator's License is required. * A CDL is a plus. * Generous benefits and competitive wages. Premium pay for qualified bilingual candidates. Please inquire within for full job description. CPI provides equal employment opportunities (EEO) to all employees and applicants for employment.

Hastings College seeks a Systems Analyst to drive the development and optimization of cutting-edge systems solutions. If you're passionate about technology and seek a dynamic role in a collaborative environment, this is the opportunity for you. Why Join Hastings College? Join Hastings College and help shape the future of a dynamic and forward-thinking institution. As a Systems Analyst, you will play a key role in supporting and enhancing the technological infrastructure of the college and collaborating with various departments to meet software workflow needs. In addition to traditional benefits, we offer a comprehensive benefits package designed to support our employees' well-being and professional growth. We provide a free individual membership to the Hastings YMCA, up to 15 paid holidays per year in addition to up to three weeks of vacation allowing for a health work-life balance. Additionally, we support lifelong learning through our tuition remission program, where employees can take up to two courses per semester, and dependents are also eligible for tuition remission. While we value the benefits of hybrid work, we are seeking an individual who can be primarily on-site at our Hastings College campus. To ensure a successful onboarding experience, the selected candidate will be expected to work fully on-site for the first 3 months. After this initial period, a hybrid work schedule may be possible to support a successful work-life balance. Job Summary: * Develop, optimize, and maintain SQL code and PowerShell scripts for efficient system automation. * Engineer ETL processes for seamless data transformation and integration. * Create and manage operational reports using BI platforms to ensure data integrity. * Provide essential support for vendor software updates, documenting system architecture changes. * Serve as a technical liaison, troubleshooting vendor package issues and facilitating communication. * Interpret user requirements, offer technical support, and maintain strong business metric understanding. * Collaborate with vendors, adapt to new technologies, and represent the institution professionally. View the job description for a full list of duties. Education & Experience: Bachelor's degree from four-year college or university in computer science, information systems, operations research, or a related field and at least two years of related experience; or equivalent combination of education and experience. Experience working with T-SQL, MySQL, or other query language required. Experience with the following is desired: SSRS, SQL Integration Services, Azure Data Factory, MSSQL Databases, PowerShell, Python, or PowerBI. Equal Opportunity Employment Hastings College is committed to supporting a welcoming academic and employment environment. The College is an Equal Opportunity employer that does not discriminate on the basis of race, ethnicity, color, national origin, religion, age, sex, marital status, pregnancy, sexual orientation, gender identity, genetic information, disability, veteran status, or any other characteristic protected by local, state, or federal laws. Apply now to join our team dedicated to optimizing technology solutions at Hastings College.

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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Hastings College seeks a Systems Analyst to drive the development and optimization of cutting-edge systems solutions. If you're passionate about technology and seek a dynamic role in a collaborative environment, this is the opportunity for you. Why Join Hastings College? Join Hastings College and help shape the future of a dynamic and forward-thinking institution. As a Systems Analyst, you will play a key role in supporting and enhancing the technological infrastructure of the college and collaborating with various departments to meet software workflow needs. In addition to traditional benefits, we offer a comprehensive benefits package designed to support our employees' well-being and professional growth. We provide a free individual membership to the Hastings YMCA, up to 15 paid holidays per year in addition to up to three weeks of vacation allowing for a health work-life balance. Additionally, we support lifelong learning through our tuition remission program, where employees can take up to two courses per semester, and dependents are also eligible for tuition remission. While we value the benefits of hybrid work, we are seeking an individual who can be primarily on-site at our Hastings College campus. To ensure a successful onboarding experience, the selected candidate will be expected to work fully on-site for the first 3 months. After this initial period, a hybrid work schedule may be possible to support a successful work-life balance. Job Summary: Develop, optimize, and maintain SQL code and PowerShell scripts for efficient system automation. Engineer ETL processes for seamless data transformation and integration. Create and manage operational reports using BI platforms to ensure data integrity. Provide essential support for vendor software updates, documenting system architecture changes. Serve as a technical liaison, troubleshooting vendor package issues and facilitating communication. Interpret user requirements, offer technical support, and maintain strong business metric understanding. Collaborate with vendors, adapt to new technologies, and represent the institution professionally. View the job description for a full list of duties. Education & Experience: Bachelor's degree from four-year college or university in computer science, information systems, operations research, or a related field and at least two years of related experience; or equivalent combination of education and experience. Experience working with T-SQL, MySQL, or other query language required. Experience with the following is desired: SSRS, SQL Integration Services, Azure Data Factory, MSSQL Databases, PowerShell, Python, or PowerBI. Equal Opportunity Employment Hastings College is committed to supporting a welcoming academic and employment environment. The College is an Equal Opportunity employer that does not discriminate on the basis of race, ethnicity, color, national origin, religion, age, sex, marital status, pregnancy, sexual orientation, gender identity, genetic information, disability, veteran status, or any other characteristic protected by local, state, or federal laws. Apply now to join our team dedicated to optimizing technology solutions at Hastings College.

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: $77,969 - $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.

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: $77,969 - $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.

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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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: $77,969 - $128,519 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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: $77,969 - $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.

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: $77,969 - $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.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. **ESSENTIAL JOB DUTIES:** + Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. + Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. + Do root cause analysis for business data issues as assigned by the team lead. + Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. + Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. + Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design + 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. + Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. + 3+ years of experience with Microsoft Azure, AWS, or Hadoop. + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. + 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. ESSENTIAL JOB DUTIES: * Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. * Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. * Assist retrospective HEDIS rate tracking and supplemental data impact reporting. * Develop Medical Record Review project reporting to track progress and team productivity reporting. * Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. * Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. * Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. * Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. * Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. * Do root cause analysis for business data issues as assigned by the team lead. * Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. * Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. * Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. * Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. * Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. Job Qualifications REQUIRED EDUCATION: Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline REQUIRED EXPERIENCE: * 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. * 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design * 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. * Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. * 3+ years of experience with Microsoft Azure, AWS, or Hadoop. * 3+ Years of experience with predictive modeling in healthcare quality data. * 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. * 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. * 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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: $77,969 - $155,508 / 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.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. **ESSENTIAL JOB DUTIES:** + Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. + Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. + Assist retrospective HEDIS rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. + Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. + Do root cause analysis for business data issues as assigned by the team lead. + Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. + Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. + Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. + Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. + 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design + 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. + Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. + 3+ years of experience with Microsoft Azure, AWS, or Hadoop. + 3+ Years of experience with predictive modeling in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. + 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. + 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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: $77,969 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects. ESSENTIAL JOB DUTIES: * Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports. * Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. * Assist retrospective HEDIS rate tracking and supplemental data impact reporting. * Develop Medical Record Review project reporting to track progress and team productivity reporting. * Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. * Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates. * Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting. * Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB. * Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis. * Do root cause analysis for business data issues as assigned by the team lead. * Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance. * Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. * Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users. * Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus. * Develop oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures. Job Qualifications REQUIRED EDUCATION: Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline REQUIRED EXPERIENCE: * 5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data. * 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design * 5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS. * Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage. * 3+ years of experience with Microsoft Azure, AWS, or Hadoop. * 3+ Years of experience with predictive modeling in healthcare quality data. * 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP. * 3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. * 3+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions PHYSICAL DEMANDS: Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 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: $77,969 - $155,508 / 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.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration in QNXT or Networx + Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is highly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education** Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. **Preferred Experience** 7-9 years 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. **KNOWLEDGE/SKILLS/ABILITIES** + Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions + Must have configuration experience in NetworX Pricer + Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution + Participates in defect resolution for assigned component + Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have healthcare experience. + Experience working with SQL is highly preferred. **JOB QUALIFICATIONS** **Required Education** + Bachelor's Degree or equivalent combination of education and experience **Required Experience** + 5-7 years of provider contract configuration experience **Preferred Education** + Graduate Degree or equivalent experience **Preferred Experience** + 7-9 years provider contract configuration experience + SQL Experience (HIGHLY PREFERRED) + NetworX Pricer experience (HIGHLY PREFERRED) 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Serves as a subject matter expert on system capabilities, conducting research and root cause analysis to resolve complex business and technical issues. Ensures system configuration aligns with business rules, regulatory requirements, and operational needs. Supports upgrades, releases, and health plan implementations while validating data integrity and recommending improvements to enhance system efficiency and quality. KNOWLEDGE/SKILLS/ABILITIES * Serves as a subject matter expert (SME) on NetworX system capabilities, leveraging system knowledge to evaluate configuration options and recommend optimal solutions * Must have configuration experience in NetworX Pricer * Conducts in-depth research and analysis to identify root causes of complex business and system issues, providing clear recommendations for resolution * Participates in defect resolution for assigned component * Designs and facilitates system knowledge training sessions to improve user understanding and operational efficiency * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have healthcare experience. * Experience working with SQL is highly preferred. JOB QUALIFICATIONS Required Education * Bachelor's Degree or equivalent combination of education and experience Required Experience * 5-7 years of provider contract configuration experience Preferred Education * Graduate Degree or equivalent experience Preferred Experience * 7-9 years provider contract configuration experience * SQL Experience (HIGHLY PREFERRED) * NetworX Pricer experience (HIGHLY PREFERRED) 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: $77,969 - $141,371 / 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.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. KNOWLEDGE/SKILLS/ABILITIES * Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. * Participates in defect resolution for assigned component * Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. * Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. * Participates in the implementation and conversion of new and existing health plans. * Must have experience in Contracts configuration in QNXT or Networx * Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. * Must have knowledge on Medicare payment methods * Experience on Hospital payment methodology & processing is essential * Understanding on hospital claims processing and configuration works * Medicare fee schedule knowledge is required * Medicaid and Duals experience is highly preferred JOB QUALIFICATIONS Required Education Bachelor's Degree or equivalent combination of education and experience Required Experience 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. Preferred Education Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. Preferred Experience 7-9 years 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: $77,969 - $141,371 / 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.

Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **KNOWLEDGE/SKILLS/ABILITIES** + Loads and maintain contract, benefit or reference table information into the claim payment system and other applicable systems. + Participates in defect resolution for assigned component + Assists with development of configuration standards and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. + Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. + Participates in the implementation and conversion of new and existing health plans. + Must have experience in Contracts configuration in QNXT or Networx + Experience in DOFR (division of financial responsibility) or CA DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is highly preferred **JOB QUALIFICATIONS** **Required Education** Bachelor's Degree or equivalent combination of education and experience **Required Experience** 5-7 years in SQL, Medicare, Networx, QNXT, claims processing and hospital claims payment method. **Preferred Education** Graduate Degree or equivalent experience Medicaid and Duals expeirence is preferred. **Preferred Experience** 7-9 years 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: $77,969 - $141,371 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.