The Requirements

To be a good fit for this opportunity you will have:

• A solid understanding of and 0 to 5 years of experience with EDI.
• Experience with SQL, an understanding of data table structures, and the ability to independently:
  • Write basic to intermediate statements and queries. Quick question for you - click here
  • Review and extract data.
  • Troubleshoot data issues independently.
• An understanding of the systems development life cycle.
• Competency in MS Office applications.
• A bachelor's Degree (preferably in Computer Science or a related field) or equivalent experience.

Just as important as your experience and skills will be the following characteristics and competencies:

• Business acumen and solid interpersonal skills, including the ability to interact effectively with coworkers and customers.
• Solid analytical and creative problem solving skills, and a willingness to explore systems and do "detective" work in the absence of documented instructions.
• The ability to learn and apply new technologies, tools and processes quickly.
• Strong verbal and written communication abilities.

Preferred but not required:

• Healthcare experience, ideally with claims, enrollment, and / or authorizations in a Medicaid environment.
• Experience with Edifecs, MS Biztalk, and / or GateWay.
• Experience with QNXT.
• Project management experience; PMP certification is a strong plus.
• Knowledge of:
  • HIPAA/EDI X12 4010/5010 healthcare-related transactions including 270-271, 276-277, 278, 834, 835, 837, 997, 999, 824, and NCPDP 5.1 & D.0.
  • Industry standard health data code sets such as ICD-9/ICD-10, CPT/HCPCS, revenue codes.
  • Regulatory requirements associated with 5010 and ICD-10.

Our preference is that you work in our Glen Allen, VA facility, but you might also work out of our Herndon, VA or Charleston, WV locations. You also will need to be willing and able to travel to client sites up to 50% of the time; however, we anticipate that your actual travel will be much less.

The Role

Reporting to the Manager, MITA Integrated Solutions & EDI, you will join a central resource team of Engineers delivering Medicaid Information Technology Architecture (MITA) solutions to support contracts with the states of New Jersey, Virginia, West Virginia and Maine. Quick question for you - click here We also provide some operational support.

The role also involves contributing, from a solution standpoint, to Implementation or Customer Support teams around one or more EDI & QNXT Data components. This will include playing a supporting role on EDI & QNXT Data teams in front of customers, helping to develop and increase their Medicaid business knowledge.

Your specific activities will include:

• Analyzing, modeling, designing, developing and implementing EDI & QNXT Data components for Medicaid sites.
• Designing, developing and implementing customized functionality for EDI & QNXT Data components to accommodate business processes related to that component.
• Representing the EDI & QNXT Data group as a member of implementation and / or customer support team.

Note: this description is intended to give you a general overview of the position and is not an exhaustive listing of duties and responsibilities.

About Health PAS

We take a fresh approach to claims processing

Molina offers highly effective, efficient administration outsourcing and decision support services. Unlike other vendor offerings, Health PAS was built from the ground up with leading-edge technology. We offer a feature-rich, best-of-breed, flexible, and scalable solution that has been specifically designed to address the unique needs of Medicaid and state-run healthcare programs. You will develop broad expertise in this leading edge technology.

Health PAS is the only commercial-off-the-shelf (COTS) software-based, MITA aligned, certified MMIS in the country and provides the advanced problem solving capabilities that are needed today. This flexible and customizable health care management solution is readily adaptable to the new realities and changes within Medicaid while helping reduce costs.

Client benefits of Health PAS:

• Attention and resources are focused on core business goals while administrative-oriented activities are managed to clients' guidelines and performance standards.
• Operation and administrative service costs are reduced due to efficiencies inherent in new technology and innovative automated workflow management.
• Costs to deliver healthcare services via preventative measures are reduced.
• Introduction of program / plan changes and new healthcare funding models are enhanced.
• Expansion of self-service capabilities and consumer communication through secure, robust Internet portals.
• Compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Why Molina

Broaden your experience with diverse challenges -- we'll look to you to develop a broad understanding of the system as a whole, and of the various parts that make it up -- in other words, a good deal of leading edge technologies. You'll interact with a variety of professionals, from desktop support specialists to system architects and get hands-on with just about all aspects of the system.

Professional development -- at Molina we support your professional development by providing strong initial training and additional supplemental training as needed. You'll learn many new technologies and processes. Molina prefers to promote from within whenever possible, so if you work hard and demonstrate your talent, you might move up into a more senior Data Engineer role, into project management or architecture, or even into other areas of Molina.

Great environment -- we'll look to you to achieve goals independently, but you'll also have support. You're always free to ask questions, make suggestions and explore better ways to do things. We all enjoy our jobs and believe that it should be fun to do what we do. If you feel the same, you'll fit right in.

Right solutions, right time -- managed care is an optimal solution to the challenges that healthcare reform is intended to address, positioning Molina for ongoing success. The whole industry is shifting, and the Medicaid market will be growing even faster than others . . . with Molina and MMS leading the way.

Help for the system and those who need it most -- Molina Healthcare provides services for the under-served and you'll find a strong sense of mission here; our people are proud to be able to make a difference in the quality of life for this vulnerable segment of our communities. Likewise, we strive to help the system, shaving costs off Medicaid and reducing impact where we can.

High-performance company -- since our founding in 1980 we have grown from a single health clinic to a multi-state industry segment leader. We continue to post strong numbers. Our annual revenue for 2012 was $6 billion, up 26% over 2011.

Excellent compensation -- in addition to a competitive salary, we offer comprehensive benefits that include all you would expect -- such as insurance and PTO -- plus some pleasant surprises. For example, we provide two paid days off annually for employees to perform volunteer work at the charity of their choice, tuition reimbursement for those continuing their education, and more.

Keys to Success

It's important enough that it bears repeating here: while your technical knowledge will be essential, just as important will be your ability to interact with internal contacts at multiple levels within Molina, as well as with contacts within customer organizations. This will include communicating effectively with both technical and non-technical people.

If you're the right fit here, you'll be the kind of person who sees challenges as opportunities, and who can understand what is needed and take the steps to make it happen. Health PAS and our other technologies make up a system of systems that few people know completely; you'll need to approach the system both with ongoing curiosity and learning agility, constantly delving deeper into the system, questioning why and how. You won't be timid about digging into a database or system to resolve an issue or figure out how to do something. There is always plenty going on, so you'll need to be able to handle multiple projects and priorities effectively. You'll also need to remain adaptable as Molina grows, and as the Medicaid environment evolves.

About Molina

MMS is uniquely positioned to help state agencies meet their health care administration and MMIS goals. We currently hold contracts with the states of Idaho, Louisiana, Maine, New Jersey, and West Virginia, as well as a contract to provide drug rebate administration services for the Florida Medicaid program. As part of the Molina Healthcare family, MMS is the only solution of its kind implemented by a health care company with more than 30 years of experience supporting state Medicaid and other government-sponsored programs.

Molina Healthcare, Inc. is a multi-state healthcare organization with flexible-care delivery systems focused exclusively on government-sponsored healthcare programs for low-income families and individuals. We are among the most experienced managed healthcare companies serving patients who have traditionally faced barriers to quality healthcare, including individuals covered under Medicaid, and Medicare, the Healthy Families Program, state Children's Health Insurance Programs (CHIP) and other government-sponsored health insurance programs.

Quality is a top priority for Molina, and all eligible Molina health plans are accredited by the National Committee on Quality Assurance, while Molina's 24-hour nurse advice line is accredited by URAC.

Molina has operations in California, Michigan, New Mexico, Ohio, Texas, Utah, Washington, Florida, Louisiana, Idaho, Maine, New Jersey, West Virginia, Virginia, and Wisconsin. It also has 17 primary care clinics in California, two clinics in Washington, three in Virginia and one clinic in both Florida and New Mexico. Molina's corporate headquarters are in Long Beach, California.