Senior Analyst, Medical Economics - UM Analytics (Remote)

Molina Healthcare; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Competitive benefits

Job summary

Molina Healthcare (United States) seeks a senior health analytics professional to support medical economics analysis. You will extract, analyze, and synthesize data from multiple sources to identify risks, opportunities, and cost improvement opportunities.

Responsibilities include data extraction, trend analysis of medical costs, pro forma analyses, and collaboration with clinical and business teams to drive affordability and performance improvements across Molina products.

Qualifications

• At least 3 years of health care analytics and/or medical economics experience.
• Expert in SQL coding and data mining with ability to audit outcomes.
• Bachelor’s degree in a quantitative or health-related field.
• Understanding of Medicaid/Medicare programs and health care plans.
• Experience building dashboards in Excel/Power BI/Tableau.

Responsibilities

• Extracts and compiles data to support executive decision-making.
• Mines and manages information from large data sources.
• Analyzes utilization and medical cost data to identify trends and cost drivers.
• Develops financial and utilization analyses to improve performance.
• Builds data-driven reports and dashboards for leadership.
• Collaborates with clinical, networks and other teams on studies.

Skills

SQL coding

Data mining

Dashboards

Data management

Analytical thinking

Attention to detail

Communication

Education

Bachelor's degree in statistics/mathematics/economics/CS/health care mgmt

Tools

SQL

Excel

Power BI

Tableau

Job description

JOB DESCRIPTION

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 authorization data for utilization management analytics with understanding of relationship between authorization and claim, utilization management reporting metrics and utilization metric outcome interpretation
• Analyzes authorization, 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.
• Expert in SQL coding through any platform. Job will require writing code daily through data mining, understanding table relationships, and auditing for outcome accuracy.
• 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.) with proficiency in utilization management.
• 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.
• Teachable attitude with curiosity for the business and analytics
• 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.

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