Demo

Process Consultant - QNXT SME

Molina Healthcare
Grand Island, NE Full Time
POSTED ON 3/29/2025
AVAILABLE BEFORE 5/28/2025
Job Summary
Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of a business process improvement capability.

Knowledge/Skills/Abilities
  • Facilitates groups for problem solving and service improvement including definition/documentation, business workflow analysis.
  • Requires high level understanding of the organization’s business and industry requirements.
  • Knowledgeable of State Medicaid contract Service Level Agreements. Demonstrates SME knowledge of MCO contract compliance requirements that impact processes.
  • Works with the business and project development teams to assess and recommend the appropriate configuration design, solutions, and methodology for new and existing business.
  • Focus is on process analysis and re-engineering, with an understanding of technical problems and solutions as they relate to the current and future business environment.
  • Creates process change by integrating new processes with existing ones and communicating these changes to impacted business teams.
  • Recommends and facilitates process improvement efforts. May lead re-engineering team and act as project manager in some cases.
  • Demonstrates use of tools, techniques and communications soft skills to build and maintain effective business relationships.
  • Understanding of complex payment methodologies, configuration solutions, health care benefits.
  • Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission.
  • Advanced knowledge of Excel and SQL knowledge preferred
  • Knowledge of configuration in QNXT strongly preferred
Job Qualifications
Required Education
Bachelor's degree required in a related field (Business Administration, Healthcare, Engineering, etc.) or 5 years of related field or equivalent experience

Required Experience
  • 5 years of process improvement experience
Required License, Certification, Association
LEAN certification and/or Lean Six Sigma Green Belt

Preferred Experience
  • Project management
  • 2 years of process improvement experience with demonstrable successes in application of Lean/Six-Sigma
Preferred License, Certification, Association
Lean Six Sigma Black Belt

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: $77,969 - $155,508 / ANNUAL
  • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Salary : $77,969 - $155,508

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