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Molina Healthcare Analyst, Financial/Healthcare in Long Beach, California

Job Description

Job Summary

Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care models.

Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably.

ESSENTIAL JOB DUTIES:

· Research, develop, analyze and recommend cost savings opportunities in alignment to support enterprise strategies

· Track, monitor, and report cost savings initiatives (hospitals, physicians, ancillary) trend analyses, and its performance on a monthly basis.

· Conduct financial modeling and analysis (including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future contract rate proposals.

· Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate/consult the health plans on the financial impact.

· Develop key strategic reports and analysis using SQL programming, SQL Server Analytic Services (SSAS), Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard.

· Generate hospital performance analytics tools on a quarterly basis; develop reports on a regular basis using SQL, Excel, and other reporting software.

· Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting

· Ability to translate contract rates and terms to evaluate the financial impact to effectively negotiate new or amended contracts (e.g. coding and chargemaster impact analysis)

· Strong written and verbal communication skills required to present analytical results and findings to healthplans’ senior management team and key stakeholder meetings (PowerPoint)

REQUIRED EDUCATION:

• Bachelor’s Degree in Business, Finance, Mathematics, Economics, Data Science or Actuarial Sciences or equivalent experience

REQUIRED EXPERIENCE:

· 3+ years of analytics experience in financial analysis, healthcare pricing, network management, healthcare economics or related discipline.

· 3+ years increasingly complex database and data management responsibilities

· Advanced level proficiency in Microsoft Excel

· Intermediate to advanced level proficiency in SQL

· 3+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

PREFERRED EDUCATION:

Master’s Degree

PREFERRED EXPERIENCE:

· Preferred experience in healthcare medical economics and/or strong financial analytics background

· 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.

· Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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