JOB DESCRIPTION
Job Summary
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.
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.
KNOWLEDGE/SKILLS/ABILITIES
- 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.
- 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.
- 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).
JOB QUALIFICATIONS
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
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)
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.
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Working at
Molina Healthcare
Molina Healthcare is a leading managed healthcare company dedicated to providing quality healthcare services to underserved communities. With a strong commitment to improving access to care, Molina Healthcare offers a wide range of health insurance plans and solutions. As an actuary at Molina Healthcare, you'll play a crucial role in assessing and managing risks to ensure the financial stability of the company's healthcare offerings. Actuaries at Molina Healthcare utilize their expertise in statistical analysis and risk assessment to develop pricing strategies, analyze healthcare trends, and provide insights that support evidence-based decision-making. Molina Healthcare's focus on serving vulnerable populations and providing cost-effective care creates unique challenges and opportunities for actuaries. Collaborating with cross-functional teams, actuaries at Molina Healthcare analyze complex healthcare data, identify trends, and develop innovative solutions that improve health outcomes while managing costs. Professional growth is highly valued at Molina Healthcare, and actuaries have access to ongoing training and development opportunities. Actuaries can enhance their skills and expertise while contributing to the company's mission of providing quality healthcare to those who need it most. Join Molina Healthcare's esteemed actuarial team and embark on a fulfilling career where you can make a meaningful impact on underserved communities, drive healthcare innovation, and enjoy a supportive work environment.