Senior Analyst, Medical Economics

Molina Healthcare • Santa Fe, NM • 2d ago

JOB DESCRIPTION Job Summary

Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance.

Essential Job Duties

Extracts and compiles data and information from various systems to support executive decision-making.

Mines and manages information from large data sources.

Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs.

Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership.

Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise.

Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives.

Collaborates with clinical, provider network and other teams to bring supplemental @context/insight to data analyses, and design and perform studies related to the quantification of medical interventions.

Collaborates with business owners to track key performance indicators of medical interventions.

Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans.

Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities.

Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports.

Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes

Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making.

Supports financial analysis projects related to medical cost reduction initiatives.

Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results.

Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business.

Supports scoreable action item (SAI) initiative tracking to performance.

Required Qualifications

At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.

Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.

Demonstrated understanding of Medicaid and Medicare programs or other health care plans.

Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)

Proficiency with retrieving specified information from data sources.

Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.

Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)

Knowledge of health care 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 arrangements

Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.

Ability to mine and manage information from large data sources.

Demonstrated problem-solving skills.

Strong critical-thinking and attention to detail.

Ability to effectively collaborate with technical and non-technical stakeholders.

Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.

Effective verbal and written communication skills.

Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.

Preferred Qualifications

Proficiency with Power BI and/or Tableau for building dashboards.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $77,969 - $155,508 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Medical Director, Rare Disease

Otsuka America Pharmaceutical Inc. • Santa Fe, NM • 14h ago

Hospital & Medical

Job Summary The Medical Director, Rare Disease is a critical role responsible for shaping the strategic processes and planning for assets in across phases of development within the Rare Disease portfolio. This position m...

14h ago

Go to Apply

Medical Director, Rare Disease

Otsuka America Pharmaceutical Inc. • Santa Fe, NM • 14h ago

Hospital & Medical

14h ago

Go to Apply

Clinical Quality Operations Manager - Remote

Merck • Santa Fe, NM • 14h ago

Hospital & Medical

Job Description In partnership with the Clinical Quality Operations Lead (CQOL and Head of CQO, the CQOM is accountable for the execution of operational quality activities within the assigned therapeutic area. This inclu...

14h ago

Go to Apply

Health Information Specialist REQ #5285

Datavant • Santa Fe, NM • 1d ago

Hospital & Medical

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is power...

1d ago

Go to Apply

Customer Service Rep - Healthcare (UMA Grads, Remote)

Concentrix • Santa Fe, NM • 3d ago

Hospital & Medical

Home ( https://jobs.concentrix.com/ ) »Job Details Customer Service Rep - Healthcare (UMA Grads, Remote) Operations ( https://jobs.concentrix.com/job-search/?category=Operations ) Location United States Of America Langua...

3d ago

Go to Apply

Customer Service / Tech Support Rep - Media (Remote)

Concentrix • Santa Fe, NM • 3d ago

Hospital & Medical

Home ( https://jobs.concentrix.com/ ) »Job Details Customer Service / Tech Support Rep - Media (Remote) Operations ( https://jobs.concentrix.com/job-search/?category=Operations ) Location United States Of America Languag...

3d ago

Go to Apply

Finance & Program Management Associate, Digital Health

Baylor Scott & White Health • Santa Fe, NM • 3d ago

Hospital & Medical

Job Summary The Finance & Program Management Associate serves as a key team player providing financial analysis and strategic planning support to the four pillars of the Digital Health space. Responsibilities Serves...

3d ago

Go to Apply

Health Information Operations Manager

Datavant • Santa Fe, NM • 3d ago

Hospital & Medical

3d ago

Go to Apply

Medical Supply Coordinator

Genesis Healthcare • Santa Fe, NM • 3d ago

Hospital & Medical

Overview At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fost...

3d ago

Go to Apply

ERP Industry Sales Executive - Healthcare Vertical, West

Oracle • Santa Fe, NM • 5d ago

Hospital & Medical

Job Description Looking to develop your already successful career in the Applications Software industry? Then Oracle offers the perfect opportunity to work for a truly Global Market Leader committed to on-going developme...

5d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.