Job TitleCandidates MUST be located within Texas. The position will start remote and could transition into the office, though this is negotiable.This role will be exclusively responsible for Texas Medicaid and CHIP Encounter Data Reconciliation (both Medical and Pharmacy). With that, this candidate will also be responsible for the following:Interfacing with cross-function business owners to ensure the compliance of Molina's Encounter data with Texas Medicaid and CHIP Encounter Data requirementsTrouble-shoot root cause for why encounter data was not accepted by the stateIdentify gaps in processes and implement improvements to close the gapReport back to the VP of Operations with findings and next stepsParticipate in workgroup meetings, team meetings and state meetings, as appropriateAssist with Trading Partner Testing to ensure the appropriate submission of encounter dataMUST HAVES:Experience with state Medicaid and CHIP Encounter DataHIPAA compliance editsNCPDP compliant format for pharmacy encountersResearch as needed using a variety of SQL, XML, EDI and file editing toolsExperience with state Medicaid and CHIP Claims DataDemonstrate and apply a strong attention to detailDemonstrated ability to research, document and translate business requirementsSchedule: 8AM – 5PM CST with overtime as needed.
Potential to convert to perm.Summary: Coordinates all product management including maintenance, upgrades/version control, capabilities determination, special reporting, documentation, and solution usage and trouble shooting. Essential Functions:Participates in the testing and implementation of solution, including the components affecting both the State and Molina.Prepares and monitors production control schedules related to components in coordination with the centralized production control unit. Confirms production control reports and audits trails support successful completion of activitiesDefines, coordinates and monitors activities and systems and customer interface requirements.Receives requests from external entities for testing and validating files, transactions, and processes; and responds to questions from external entities related to process testing and processing requirements.Coordinates and works with the site based operational management staff to receive and responds to requests for information related to project.Develops scheduling and controls processes to complete activities according to defined contractual service level agreements.Establishes production control monitoring processes to validate that production control standards, timelines, balance and control activities, service levels, and metrics are attained as defined in the service level agreements.Plans for initiate mitigation strategies when production control activities and standards are not attained.Conducts technical training for the operations staff to ensure that all technical requirements are understood and can be successfully related internally with the operations staff and the customer.
Produces metrics data reports and financial summary reports related to the processing.State Plan / Department Specific Duties and Responsibilities:May conduct administrative services for site procurements and account invoicing and cash management when requested to assist.May manage site-based supply procurement activities.May prepare invoices for account billing.Knowledge/Skills/Abilities:Demonstrated understanding of Microsoft Windows; proficient in Excel and AccessDemonstrated capability using reporting software and/or packages, e.g., Crystal Reports, SQL, and CypressExcellent verbal and written communication skillsAbility to abide by Molina's policiesAbility to maintain attendance to support required quality and quantity of workMaintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customersRequired Education: Bachelor's Degree in Business or Information Technology or equivalent experienceRequired Experience: 2-4 years experience 2-4 years SQL, MS Office Suite, QNXT experience Proven experience and knowledge of health care claims administrative environment. Proven client-facing skills required; including the ability to prepare meaningful metrics related to processing activities.Comments for Suppliers: DO NOT SUBMIT CANDIDATES WHO WERE PREVIOUSLY SUBMITTED TO REQ 15920