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.
• Develops, implements and uses software and systems to support the department's goals.
• Develops and generates ad-hoc and standard reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, 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.
• Participate in and guide the design of large scale predictive and statistical models to predict future trends in cost, utilization and performance. Guide team members on appropriate writing skills for executive summaries tailored to the audience.·
• 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.
• Manage the creation of comprehensive workflows for the production and distribution of assigned reports; document reporting processes and procedures.
• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.
• Create comprehensive workflows for the production and distribution of assigned reports; document reporting processes and procedures.
• Assist 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.
• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
• Bachelor's Degree in Finance, Economics, Computer Science
• Five or more years of progressive responsibilities in Data, Finance or Systems Analysis
• Expert knowledge on SQL, SSRS and SSIS or similar tools
• Bachelor's Degree in Finance, Economics, Math, or Computer Science
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
• 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
• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
• Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions
• Multiple data systems and models
• BI tools (ProClarity, MEd Insight, etc.,)
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.
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