Senior Analyst, Medical Economics

Molina Healthcare • Arizona, Arizona • 13h 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

Optometrist

America's Best • Casa Grande, AZ • 20min ago

Hospital & Medical

At our practice, we believe that the optometrist is the hero of primary eye care, enabling and safeguarding their patient's ability to experience his or her best vision. For many people, an optometrist is also the first...

20min ago

Go to Apply

Physical Therapist- Home Health

BAYADA Home Health Care • Oracle, AZ • 1h ago

Hospital & Medical

Make an Impact as a Physical Therapist (PT) at BAYADA Home Health Care **Up to $5,000 Sign on Bonus Seeking candidates to service the Oracle, San Manuel, and Mammoth area.** BAYADA Home Health Care is currently seeking a...

1h ago

Go to Apply

Medical Transportation Driver - $10,000 Guarantee + Bonus

Veyo • Yuma, AZ • 2h ago

Hospital & Medical Sponsored

Have a car? Earn a $1,000 BONUS + $10,000 GUARANTEE* when you sign up to drive your own vehicle and help transport others to healthcare appointments around Yuma! Veyo is a mission-driven company helping individuals get t...

2h ago

Go to Apply