JOB DESCRIPTION
Provides analyst‑level support for Configuration Information Management (CIM) activities, including Directed Payment Program (DPP) and Atlis pricing oversight, ensuring accurate and timely implementation and maintenance of configuration data within claims and operational systems. Responsible for analyzing state and federal requirements, provider contracts, benefits, authorizations, and fee schedules into system configuration parameters. Ensures synchronization across systems, validates configuration accuracy, and supports claims issue resolution to maintain compliance with business, regulatory, and system requirements.
Essential Job Duties
- Oversight of configuration and maintenance of benefit plans, provider contracts, fee schedules, DPP rate tables, Atlis pricing logic, and supporting system tables within claims platforms (e.g., QNXT, Networx).
- Analyze and interpret state and federal requirements (Medicaid, Medicare, Marketplace), including Directed Payment Program rules and alternate pricing methodologies (Atlis), and convert these requirements into system configuration parameters.
- Translate HHSC/CMS guidance, provider contract language, rate exhibits into executable configuration for base rates, add‑ons, and supplemental payments.
- Ensure configuration aligns with approved payment methodologies and program‑specific requirements and maintain Directed Payment Program (DPP) rates and payment structures, including component‑based and retroactive rate updates.
- Collaborate with Finance, Operations, and Configuration teams to ensure DPP payments are applied correctly and comply with state‑approved methodologies.
- Perform root‑cause analysis to differentiate configuration defects from contract, benefits, policy, and upstream data issues.
- 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 configuration information management experience maintaining databases, and/or analyst experience working within a health care operations setting, or equivalent combination of relevant education and experience.
- Experience using a claims processing system.
- Experience verifying documentation related to updates/changes within a claims processing system.
- Experience validating and confirming information related 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-quality/on-time delivery
- Strong attention to detail.
- Effective verbal and written communication skills.
- Microsoft Office suite proficiency, including Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency.
Preferred Qualifications
- Experience in a managed care organization supporting Medicaid, Medicare and/or Marketplace programs.
- Experience supporting Medicaid Directed Payment Programs (DPP) and/or alternate pricing models.
- Intermediate to advanced Microsoft Excel skills.
- Experience with claims root cause analysis and remediation.
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
