JOB DESCRIPTION
Job Summary
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 identify and track savings opportunities. Coordinates and leads trend review meetings related to clinical programs and initiatives for the Medicaid line of business.
Essential Job Duties
- Provides oversight for medical economics team and activities - ensuring delivery of work/project plans and required reporting.
• Recruits, hires, onboards, mentors, develops, and manages medical economics staff.
• Provides daily management of data management, tools and technology work streams.
• Facilitates workload distribution of new reports and project requests.
• Acts as a resource to team for medical economics/analysis related questions.
• Reviews medical economics analysis work products to ensure accuracy and clarity.
• Reviews regulatory reporting requirements and health plan project documentation.
• Maintains reporting service level benchmarks for enterprise information management (EIM) team.
• Represents medical economics department in cross-departmental and operational meetings.
• Serves as liaison between EIM and medical economics for reporting needs.
• Manage the delivery and presentation of monthly trend and performance review presentations
• Interfaces and maintains positive interactions with Medicaid leadership and Medical Economics personnel
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.
offers a competitive benefits and compensation package. is an Equal Opportunity Employer (EOE) M/F/D/V
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