Analyst, Configuration Oversight - Claims audit

JOB DESCRIPTION Job Summary

Provides analyst oversight support for payment integrity post payment recovery concepts. Responsible for accurate and timely implementation and maintenance of the payment integrity post pay recovery concepts, validating data housed on databases and ensuring adherence to business and system requirements of Molina health plans as it pertains to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, business coding and billing requirements, and accuracy of payment methodologies critical to claim processing and adjudication accuracy. Facilitates end-to-end claim/concept quality assurance (QA) audits, maintains audit records, provides counsel regarding audit findings and interpretation, monitors and controls backlog and workflow of audits, and ensures that audits are completed in a timely fashion and in accordance with audit standards.

**Essential Job Duties**

• Analyze and interpret cl...

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