Molina Healthcare
Lead Analyst, Healthcare Analytics- Managed care analytics & financial contracts
Molina Healthcare, Salt Lake City, Utah, United States, 84193
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, and 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.
Manages the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
Creates new databases and reporting tools for monitoring, tracking, and trending based on project specifications.
Creates comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
Assists 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.
Demonstrates healthcare experience in contract modeling, analyzing relevant financial and utilization metrics of healthcare.
Acts as a liaison between finance and network contracting as well as other external teams.
Has experience in financial modeling, identifying utilization management trends, and monitoring pair mix.
Has experience with Medicaid contract analytics (highly preferred).
Has experience working on managed care analytics and healthcare reimbursement models (required).
Can 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, Power BI, 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 identifies and investigates complex suspect areas regarding contract rate and related medical costs.
Initiates in-depth analysis of suspect/problem areas and suggests a corrective action plan.
Applies investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics.
Analyzes trends in medical costs to provide analytic support for finance, pricing, and actuarial functions.
Works with multiple data systems and models.
Uses 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.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.*
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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, and 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.
Manages the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
Creates new databases and reporting tools for monitoring, tracking, and trending based on project specifications.
Creates comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
Assists 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.
Demonstrates healthcare experience in contract modeling, analyzing relevant financial and utilization metrics of healthcare.
Acts as a liaison between finance and network contracting as well as other external teams.
Has experience in financial modeling, identifying utilization management trends, and monitoring pair mix.
Has experience with Medicaid contract analytics (highly preferred).
Has experience working on managed care analytics and healthcare reimbursement models (required).
Can 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, Power BI, 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 identifies and investigates complex suspect areas regarding contract rate and related medical costs.
Initiates in-depth analysis of suspect/problem areas and suggests a corrective action plan.
Applies investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics.
Analyzes trends in medical costs to provide analytic support for finance, pricing, and actuarial functions.
Works with multiple data systems and models.
Uses 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.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.*
#J-18808-Ljbffr