Job Details

Job Summary

As a Lead Analyst in Healthcare Reporting & Analytics, you will conduct in-depth research and analysis of complex healthcare claims, pharmacy, and lab data to evaluate network utilization and implement cost containment strategies. Your insights will lead to impactful healthcare utilization and cost containment reports, providing actionable recommendations based on your findings.

Key Responsibilities

• Conduct comprehensive healthcare analyses, including quantification of healthcare costs and management of databases to support quality initiatives and regulatory mandates.
• Lead small to large-scale projects for both health plan and Corporate Parent, ensuring timely delivery of objectives.
• Design and develop innovative solutions tailored to business needs utilizing various technologies.
• Analyze inbound requests to determine optimal technology solutions for efficient delivery.
• Establish quality oversight mechanisms, including reconciliation guidelines, mentoring, and training for new employees.
• Provide Administrator-level support for SharePoint and reporting services to enhance data accessibility.
• Drive the goals of the Finance, Research and Analytics team with dedication and efficiency.
• Prioritize and complete tasks and report requests efficiently through the SharePoint request system.
• Collaborate with clinical departments, focusing on utilization management and authorizations.
• Gain insights from Managed Care/Payer or medical system data and understand relevant coding systems like ICD-10, CPT, and HCPCS.
• Manage recurring and ad-hoc reporting, developing codes and builds independently where needed.
• Utilize meticulous process documentation and maintain version control.
• Adeptly query claims and membership data, demonstrating a deep understanding of claims data and membership files.
• Leverage advanced expertise in SQL, MS Excel, and PowerBI for data validation and reporting.
• Exhibit strong soft skills such as communication, stakeholder management, documentation, initiative, and presentation prowess.

Qualifications

Education:

Bachelor's Degree or an equivalent combination of education and experience; a Master's degree in a related field is preferred.

Experience:

5-7 years of relevant experience is required; 7-9 years is preferred.

Molina Healthcare is dedicated to providing a competitive benefits and compensation package and is an Equal Opportunity Employer (EOE) M/F/D/V. If you are currently a Molina employee and wish to apply, please do so through the intranet job listing.