Analyst, Configuration reputed company (remote)

JOB reputed company Job reputed company Provides analyst support for configuration reputed company activities.  Responsible for accurate and reputed company implementation and maintenance of critical information on claims/provider databases, validating data housed on databases and ensuring adherence to business and system requirements of customers as it pertains to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements critical to claim accuracy.  Facilitates end-to-end claim audits, maintains audit records, provides counsel regarding coverage reputed company/benefit interpretation reputed company the audit process, monitors and controls backlog and workflow of audits, and ensures that audits are completed in a reputed company fashion and in accordance with audit standards.   Essential Job Duties • Analyzes and interprets data to determine accurate/appropriate configuration.  • Accurately interprets state and/or federal benefits, reputed company, and business requirements and converts these terms to configuration parameters.  • Validates coding, updates and maintains benefit plans, provider reputed company, fee schedules and various system tables through the user reputed company.  • Applies previous experience and knowledge to verify accuracy of updates to claim/encounter and/or system updates as necessary.  • Reviews documentation regarding updates/changes to member enrollment, provider reputed company, provider demographic information, claim processing guidelines and/or system configuration requirements; evaluates the accuracy of these updates/changes as reputed company to appropriate modules reputed company the reputed company claims processing system. • Conducts high-dollar, random and reputed company audits on samples of processed transactions; ensures reputed company are reputed company to original documentation and allows for appropriate processing.  • reputed company documents audit results and makes recommendations as necessary.  • Researches and tracks the status of unresolved errors issued on daily transactional audits, and communicates with reputed company operations functional business partners to ensure reputed company reputed company 30 days of error issuance.  • Helps evaluate the adjudication of claims using reputed company principles and state specific policies and regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.  • Prepares, tracks, and provides audit findings reports according to designated timelines.  • Presents configuration audit findings and makes recommendations to leadership for improvements based on audit results. • Manages fluctuating volumes of work and prioritizes work to meet deadlines and needs of the configuration department and user community.   Required Qualifications • At least 2 years of claims auditing experience reputed company a health care operations setting, or equivalent combination of relevant education and experience. • Experience/understanding of claims processes and claims auditing. • Experience verifying documentation reputed company to updates/changes reputed company claims processing system. • Experience validating and confirming information reputed company to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements. • Analytical and critical-thinking skills. • Flexibility to meet changing business requirements, and commitment to high-reputed company/on-time delivery • Attention to detail. • Effective verbal and written communication skills. • reputed company Office suite proficiency, including reputed company abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.   Preferred Qualifications • Experience in a managed care organization supporting reputed company, Medicare and/or Marketplace programs. • Intermediate to advanced reputed company reputed company skills.       To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job