Molina Healthcare
Sr Analyst, Medical Economics - REMOTE
Molina Healthcare, Long Beach, California, us, 90899
Job Description
JOB DESCRIPTION
Job Summary
The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities.
Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.
Job DutiesExtract and compile information from various systems to support executive decision-makingMine and manage information from large data sources.Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs.Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions.Work with business owners to track key performance indicators of medical interventionsPerform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiativesProactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action planDraw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterpriseAnalyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to managementLead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reportsServe as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changesProvide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision makingSupport Financial Analysis projects related to medical cost reduction initiativesSupport Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired resultsKeep abreast of Medicaid and Medicare reforms and their impact on Molina HealthcareJob Qualifications
Required Education:
Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field.
Required Experience, Knowledge, Skills, and Abilities:
5+ years of related experience in healthcareDemonstrated understanding of Medicaid and Medicare programs or other healthcare plansAnalytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)Proficiency with Excel and SQL for retrieving specified information from data sources.Experience with building dashboards in Excel, Power BI, and/or Tableau and data managementKnowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. •Understanding of value-based risk arrangementsExperience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcareAbility to mine and manage information from large data sources.Preferred Qualifications:
Proficiency with Power BI and/or Tableau for building dashboardsExperience with Databricks and TOAD Data Point
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.
#PJCorp
#LI-AC1
JOB DESCRIPTION
Job Summary
The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities.
Responsible for conducting complex analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.
Job DutiesExtract and compile information from various systems to support executive decision-makingMine and manage information from large data sources.Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs.Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions.Work with business owners to track key performance indicators of medical interventionsPerform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiativesProactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action planDraw actionable conclusions based on analyses performed, make recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterpriseAnalyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to managementLead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reportsServe as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changesProvide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision makingSupport Financial Analysis projects related to medical cost reduction initiativesSupport Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired resultsKeep abreast of Medicaid and Medicare reforms and their impact on Molina HealthcareJob Qualifications
Required Education:
Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field.
Required Experience, Knowledge, Skills, and Abilities:
5+ years of related experience in healthcareDemonstrated understanding of Medicaid and Medicare programs or other healthcare plansAnalytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)Proficiency with Excel and SQL for retrieving specified information from data sources.Experience with building dashboards in Excel, Power BI, and/or Tableau and data managementKnowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms. •Understanding of value-based risk arrangementsExperience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcareAbility to mine and manage information from large data sources.Preferred Qualifications:
Proficiency with Power BI and/or Tableau for building dashboardsExperience with Databricks and TOAD Data Point
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.
#PJCorp
#LI-AC1