What are the responsibilities and job description for the Senior Business Analyst, Payment Integrity, Virginia Health Plan position at Molina Healthcare Group?
Job Description
JOB DESCRIPTION
This position will offer remote work flexibility; however, the ideal candidate will reside in the eastern time zone
Job Summary
Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action.
KNOWLEDGE/SKILLS/ABILITIES
- Interprets state and federal guidelines to ensure accuracy and compliance for Payment Integrity Edits and Initiatives
- Reviews coding guidelines to determine appropriate claims processing
- Elicit requirements using interviews, document analysis, and requirements workshops, business process descriptions, use cases, business analysis, task and workflow analysis.
- Interpret customer business needs and translate them into application and operational requirements
- Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as needed.
- Work with operational leaders within the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements.
- Create Business Requirements Documents, Test Plans, Requirements Traceability Matrix, User Training materials and other related documentations.
- Actively participates in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements.
JOB QUALIFICATIONS
Required Education
- Bachelor's Degree or equivalent combination of education and experience
Required Experience
- 5-7 years of business analysis experience,
- 6 years managed care experience.
- Demonstrates proficiency in a variety of concepts, practices, and procedures applicable to job-related subject areas.
Preferred Experience
- 3-5 years of formal training in Project Management
- Experience working with complex, often highly technical teams
- Experience working with medical coding, claims
Preferred License, Certification, Association
- Certified Professional Coder/AAPC Coding Certified or Billing Certified, Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis 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.
Job Info
Job Identification: 2030360
Job Category: Cross-Enterprise Roles
Posting Date: 2025-02-20T18:39:44 00:00
Job Schedule: Full time
