Senior Analyst, Medical Economics
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 Duties
Extract and compile information from various systems to support executive decision-making
Mine 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 interventions
Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives
Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan
Draw 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 enterprise
Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management
Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports
Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes
Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making
Support Financial Analysis projects related to medical cost reduction initiatives
Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare
Job 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 healthcare
Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
Analytical 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 management
Knowledge 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 arrangements
Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
Ability to mine and manage information from large data sources.
Preferred Qualifications:
Proficiency with Power BI and/or Tableau for building dashboards
Experience 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.
Apply Now
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 Duties
Extract and compile information from various systems to support executive decision-making
Mine 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 interventions
Perform pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives
Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan
Draw 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 enterprise
Analyze the financial performance of all Molina Healthcare products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management
Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports
Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes
Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making
Support Financial Analysis projects related to medical cost reduction initiatives
Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare
Job 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 healthcare
Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
Analytical 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 management
Knowledge 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 arrangements
Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
Ability to mine and manage information from large data sources.
Preferred Qualifications:
Proficiency with Power BI and/or Tableau for building dashboards
Experience 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.
Apply Now