QNXT Configuration Specialist - Sr. Job in Kenosha Top Essex Careers

Job Description

Job Summary

Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide.

Knowledge/Skills/Abilities

• Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines.

• Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.

• Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management.

• Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions.

• Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related.

• Coordinate, facilitate and document audit walkthroughs.

• Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal.

• Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed..

• Ability to write SQL queries

• Experience with QNXT configuration

• Experience with troubleshooting and analyzing issues.

• Experience working in a Medicare environment is highly preferred.

• Claims adjudication experience is highly preferred. Job Qualifications Required Education Associate's Degree or two years of equivalent experience Required Experience - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education Bachelor's Degree Preferred Experience - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $80,168 - $116,835 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.