Remote Risk Adjustment Coder Jobs in Cypress, CA

JOB DESCRIPTION 

Job Summary

Provides senior-level analytical support for medical economics initiatives, including extracting, analyzing, and synthesizing data from multiple sources. Identifies and quantifies cost-saving opportunities and communicates insights clearly in presentations to support broader understanding and adoption. Analyzes trends and identifies root causes of performance gaps and improvement opportunities.

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 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.
Presents analytical findings concisely to broader audience for adoption

Required Qualifications
At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
Experience writing code in SQL or SAS to retrieve and manage information from large data sources
Proficiency with retrieving specified information from data sources
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.)
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.
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.
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

Experience in Medical Economics
Business stakeholder management
Familiarity with Python or R 
 

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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