Business Analyst (Payment Integrity pre-pay) - Molina Healthcare

**JOB DESCRIPTION** **Job Summary** Analyzes complex business problems and issues within Payment Integrity Pre-Pay using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Works with CPT, HCPCS, ICD-9 and ICD-10 coding systems within Medicare & Medicaid regulations. Will support stakeholders with claims processing, reimbursement concepts, and identifying trends, discrepancies and opportunities for cost avoidance. **KNOWLEDGE/SKILLS/ABILITIES** + Provides analytical, problem solving foundation including: definition and documentation, specifications. + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. + Reviews, researches, analyzes and evaluates all data relating to specific area of expertise. Begins process of becoming subject matter expert. + Conducts analysis and uses analytical skills to identify root cause and assist with problem management as it relates to state requirements. + Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery and cost savings regulations are met + Prepares high level user documentation and training materials as needed. **JOB QUALIFICATIONS** **Required Education** Associate's Degree or equivalent combination of education and experience **Required Experience** + 3-5 Years of business analysis + 4+ years managed care experience + Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas. **Preferred Education** Bachelor's Degree or equivalent combination of education and experience **Preferred Experience** + Understanding Medicare and Medicaid regulations + Understanding claims processing and reimbursement concepts + Proficiency in analyzing healthcare data to identify trends, discrepancies, and opportunities for cost avoidance + Strong analytical thinking skills + Excellent verbal and written communication skills + The ability to work effectively with cross-functional teams and establish credibility 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: $19.64 - $42.55 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.