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JOB DESCRIPTION

Job Summary

Leads and manages team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.

Essential Job Duties

Provides oversight for medical economics team and activities - ensuring delivery of work/project plans, meeting deadlines, and required reporting.
Responsible for all trend analysis into medical cost trends identifying why they are increasing/decreasing instead of focusing on what is causing it.
Responsible for all SAI sizing, tracking, and budgeting including month-to-month changes and identifying why they are under or overperforming.
Responsible for all meeting presentations and meeting all style guide requirements
Responsible for tracking all projects in progress and completed for the medical economics team and keeping this up to date
Reviews medical economics analysis work products to ensure accuracy and clarity.
Represents medical economics department in cross-departmental and operational meetings.
Collects, validates, analyzes, and organizes data into meaningful reports for leadership decision making, and designs, develops, tests and deploys reports to other end users for operational and strategic analysis.
Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns and medical management.
Collaborates with and provides medical economics subject matter expertise for health plans and enterprise teams.
Recruits, hires, onboards, mentors, develops, and manages medical economics staff.
Facilitates workload distribution of new reports and project requests.
Reviews, evaluates, and improves business logic and data sources.
Acts as a resource to team for medical economics/analysis related questions.
Coordinates with other medical economics teams to meet data analysis and database development needs.

Required Qualifications

At least 7 years of health care analytics and/or medical economics experience, preferably in claims processing environment and/or health care environment, or equivalent combination of relevant education and experience.
At least 1 year of management/leadership experience.
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.)
Strong knowledge of queries 2005/2008 SSRS and Power BI report development.
Familiar with relational database concepts, and SDLC concepts.
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.)
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.
Strong verbal and written communication skills.
Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V