Business Analyst (Payment Integrity pre-pay)

About the position

The Business Analyst (Payment Integrity Pre-Pay) role at Molina Healthcare involves analyzing complex business problems within the Payment Integrity Pre-Pay domain. The analyst will utilize data from various sources to provide insights to decision-makers, identify trends, and support stakeholders in claims processing and reimbursement concepts. The position requires familiarity with coding systems and regulations related to Medicare and Medicaid, as well as the ability to document and improve business processes.

Responsibilities
? Analyze complex business problems and issues within Payment Integrity Pre-Pay using data from internal and external sources.
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? Identify and interpret trends and patterns in datasets to provide insights to decision-makers.
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? Support stakeholders with claims processing and reimbursement concepts.
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? Identify trends, discrepancies, and opportunities for cost avoidance.
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? Review, research, analyze, and evaluate data related to specific areas of expertise.
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? Conduct analysis to identify root causes and assist with problem management as it relates to state requirements.
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? Analyze business workflow and system needs for conversions and migrations to ensure compliance with regulations.
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? Prepare high-level user documentation and training materials as needed.

Requirements
? Associate's Degree or equivalent combination of education and experience.
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? 3-5 years of business analysis experience.
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? 4+ years of managed care experience.
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? Familiarity with a variety of concepts, practices, and procedures applicable to job-related subject areas.

Nice-to-haves
? Bachelor's Degree or equivalent combination of education and experience.
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? Understanding of Medicare and Medicaid regulations.
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? Understanding of claims processing and reimbursement concepts.
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? Proficiency in analyzing healthcare data to identify trends, discrepancies, and opportunities for cost avoidance.
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? Strong analytical thinking skills.
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? Excellent verbal and written communication skills.
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? Ability to work effectively with cross-functional teams and establish credibility.

Benefits
? Competitive benefits and compensation package.

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