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Molina Healthcare Sr Analyst, Healthcare Analytics - Encounters/Claims/Risk Adjustment/SQL in United States

Job Description

Job Summary

Designs and implements processes and solutions for organization's encounter submission. Requires both business and technical knowledge regarding the life cycle of a claim/encounter. Ability to collaborate and have open dialogue with Operations, IT, and Finance to identify root cause and develop solutions.

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.


• Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed.

• Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software.

• Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.

• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework.

• Responsible for timely completion of projects, including timeline development and maintenance; coordinates activities and data collection with requesting internal departments or external requestors.

• Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes.

• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors.

• 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.

Job Qualifications

Required Education

• Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities

• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics

• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare

• Basic knowledge of SQL

Preferred Education

• Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

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

• Healthcare Analyst I or Financial/Accounting Analyst I experience desired

• Multiple data systems and models

• BI tools

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.