Job Details

Overview

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.

Responsibilities

• Provides healthcare analysis including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory mandates, and claims data coordination.
• Manages small to large scale projects initiated by both health plan and Corporate Parent.
• Designs and develops solutions to support business needs using various technologies.
• Analyzes all inbound requests and determines appropriate technology solution for an effective and efficient delivery.
• Quality oversight mechanisms to include reconciliation guidelines, mentoring guidance and new employee training.
• Provides Administrator level support for share point and reporting services.
• Accomplishes the goals and objectives of the Finance, Research and Analytics team.
• Responsible for prioritization and timely completion of all tasks and report requests as assigned thru the share point request system.
• Ideal candidate will have experience working with the clinical departments including utilization management/authorizations
• Experience working with Managed Care/Payer or Hospital/other medical systems data is required.
• Understanding of ICD-10 codes, CPT/HCPCS codes, and membership files preferred
• Must have experience managing recurring and ad-hoc reports including independently developing build/code for ad-hoc reports.
• Utilizes excellent process documentation skills and understands version control.
• Possesses a firm understanding of claims and membership data, and is familiar with querying data from claims and membership tables, along with other data sources.
• Experience in data analysis, data validation and reporting using SQL (advanced level), MS Excel (advanced level), PowerBI is required.
• Soft skills include but are not limited to: Excellent communication, stakeholder management, documentation, self-starter, presentation skills.

Required Education

Associate degree or equivalent combination of education and experience

Required Experience

1-3 years

Preferred Education

Bachelor's Degree or equivalent combination of education and experience

Preferred Experience

3-5 years

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.