JOB DESCRIPTION

****Candidates must be located in California and work PST hours.****

Job Summary

Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES

Develops, implements, and uses software and systems to support the department's goals. Develops and generates ad-hoc and standard reports using SQL programming, excel , Databricks and other analytic / programming tools. Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring. Provides peer review of critical reports and guidance on programming / logic improvements; provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance.  Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework. Manage the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. Create new databases and reporting tools for monitoring, tracking, and trending based on project specifications. Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. Maintains SharePoint Sites as needed, including training materials and documentation archives. Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of Healthcare. Must be able to act as a liaison between Finance and Network Contracting as well as other external teams. Must have experience in Financial modeling, identifying Utilization mgmt. trends and monitor pair mix.  Experience with Medicaid contract analytics is highly preferred. Experience working on Managed care analytics and healthcare reimbursement models is required. Must be able to work in a cross functional team.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

6+ years of progressive responsibilities in Data, Finance or Systems Analysis    Expert knowledge on SQL, PowerBI, Excel, Databricks or similar tools                                                                                                            

Preferred Education

Bachelor's Degree in Finance, Economics, Math, Accounting or related fields 

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:

Proactively identify and investigate complex suspect areas regarding contract rate and related medical costs Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, etc. Analysis  of trends in medical costs to provide analytic support for finance, pricing, and actuarial functions Multiple data systems and models BI tools (Power BI)

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

 

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.