Lead Analyst, Configuration Oversight (COB/ Audit Quality & Accuracy/ Claims Configuration)

KNOWLEDGE, SKILLS & ABILITIES (Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job): • Trains audit staff on configuration functionality, enhancements and updates. • Accurately interprets end to end business requirements and able to confirm outcomes meet the specific state/federal requirements. • Creates management reporting tools to enhance audit communication on configurations accuracy results and/or audit findings • Writes complex ad-hoc report • Interprets and validates accuracy of complex MRDT and other configuration update scripts • Assists manager in establishing standards, guidelines, and best practices for the audit team • Interprets and validates accuracy of complex reports and automated configuration processes/solutions • Assist manager in establishing peer review standards and methodolog • Leads peer reviews • Research and review new audit tools and techniques and provide recommendations to management • Validates accuracy of new complex configuration processes/solutions • Verifies accuracy of MRDT, fee schedule, premium, AutoQ, and other file load packages • Interprets complex business problems and technical issues • Effectively communicates audit findings and/or outcomes through review meetings, written communications, and, workflow diagrams. • Helps drive solution to successful implementation by directing technical and business resources during all phases of the software development life cycle • Gains a deep understanding of Molina claims life cycle and all processes that affect claims payment • Develops and maintain standards and best practices for the team • Mentors junior auditors • Participates in or leads project meetings • Understands QNXT, AutoQ, and MCG functionality and schema • Writes Requirements for BRDs/FRDs and Reports without needing mentoring • Suggests schema/solution. Works with technical resource to determine best solution. • Manages complex projects from requirements to deployment, including work assignment, prioritization, issue triage etc. • Researches complex issues\ • Acts as a team lead, assigning and prioritizing work for other team members as needed JOB FUNCTION: • Responsible for accurate and timely auditing of critical information on claims databases. • Maintains critical auditing and outcome information. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. • Validate accuracy of configuration and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. • Responsible for work load assignment to auditors. • Train and coach new employees . • Provide clear and concise results and comments to leaders about focal and and random audits across all states. • Monitors and controls workflow. • Ensures that audits are conducted in a timely fashion and in accordance with unit standards. REQUIRED EDUCATION: Bachelor’s Degree or equivalent combination of education and experience REQUIRED EXPERIENCE: 5-6 Years REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: PREFERRED EDUCATION: Graduate Degree or equivalent experience PREFERRED EXPERIENCE: 7+ Years PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: 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