Remote Risk Adjustment Coding Jobs in California

Job Description
JOB DESCRIPTION
Job Summary
Provides subject matter expertise consultancy and leadership 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 information from various systems to support executive decision-making.
• Mines and manages information from large data sources.
• Analyzes and researches utilization and unit cost medical cost drivers.
• Converts data into usable information - packaging and delivering the results to senior leadership, telling the story through data visualization, collaborates with clinical, provider network and other personnel to bring supplemental context and insight to data analyses.
• Provides consultative support and medical cost-based analysis of markets and network initiatives.
• Consults with payment integrity, finance and actuarial.
• Supports the development of scoreable action items by identifying outlier cost issues.
• Performs drill-down analysis to identify medical cost trend drivers; advises network of contracting opportunities to mitigate future trends.
• Tracks, documents and takes responsibility for all aspects of related work from beginning to end of a project.
• Supports scoreable action item (SAI) initiative tracking to performance.
Required Qualifications
• At least 5 years of health care analytics and/or medical economics experience, including experience in the health care/managed care industry and knowledge of provider contracting, provider reimbursement, patient management, product and/or benefits design, or equivalent combination of relevant education and 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.)
• 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.
• 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 working with medical and pharmacy claims, authorization data, benefits design, medical management and knowledge of business functions/impact on financials (underwriting, sales, product development, network management).
• Proficiency with Power BI and/or Tableau for building dashboards.
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