Lead Healthcare Analyst (542BR) Columbus, Ohio

POSITION SUMMARY
Lead Healthcare Analyst is an individual contributor role that provides lead healthcare analysis for the state health plans, including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory mandates, and claims data coordination.

Manages small to large scale projects initiated by both health plan and Corporate Parent.  Designs and develops solutions to support business needs using various technologies.  Analyzes all in bound requests and determines appropriate technology solution for an effective and efficient delivery.  Quality oversight mechanisms to include reconciliation guidelines, mentoring guidance and new employee training.  Provides Administrator level support for share point and reporting services.  Accomplishes the goals and objectives of the Finance, Research and Analytics team.  Responsible for prioritization and timely completion of all tasks and report requests as assigned thru the share point request system.

DUTIES AND RESPONSIBILITIES
•Responsible to produce and distribute various reports (exception reports, standard reports and performance reports) to appropriate departments.

•Responsible for error resolution, follow up and performance metrics monitoring.

•Ensures a highest quality of delivery on every project/requests. 

•Develops, implements and uses software and systems to support the department’s goals.

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

•Assists 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.

•Develops new R&A staff training curriculum with team.

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

•Establishes and maintains positive working relationships with internal customers and external vendors, including individuals who are supervised by others.

•Provides leadership to other members of the team, including training of Healthcare Analyst level personnel and internal customers. 

•Provides necessary technical and business guidance to team to achieve their goals and be a mentor as needed.

•Takes ownership of Reconciliation process that includes development, maintenance, report submission and follow up with state for the outstanding payments.

STATE PLAN / DEPARTMENT SPECIFIC DUTIES AND RESPONSIBILITIES
•New Reports development.

•Manage Reporting Environment (SSRS), provide guidance and training to other Healthcare Analysts in the team.

•Develop R&A staff training curriculum with team.

•Ownership of Delivery Reconciliation process that includes development, maintenance, report submission and follow up with state for the outstanding payments.

•Manage report remediation for projects including Duals, Medicaid expansion & reprocurment and ABD Kids.

•Take ownership of ED census process that includes break fix and new hospital implementations.

•Responsible to load the PMF data on weekly basis.

•Implement SQL standardization and assist in developing segments.

•Ensure regulatory report submissions like Hospital Incentive, Semi Annual Prompt Pay and Cost reports etc.

•Perform QA to ensure the quality of the results specifically CMD requests and develop summaries for every request.

KNOWLEDGE, SKILL AND ABILITIES:
•Ability to manage various sources of information and large data sets including pharmacy, claims and encounter data

•Proficiency in compiling data, creating reports and presenting information, including expertise with SSRS (or similar reporting tool), SSIS, SQL query, MS Access and MS Excel

•Ability to combine clinical and financial data

•Demonstrated ability to meet established deadlines

•Ability to function independently and manage multiple projects

•Ability to develop scenario analysis using different approaches

•Ability to present ideas and information concisely to varied audiences

•Proficiency with PC-based systems, and the ability to learn other systems through knowledge of MS Excel and Access

•Excellent verbal and written communication skills

•Ability to abide by Molina’s policies

•Maintain regular attendance based on agreed-upon schedule, yet be flexible enough to work off hours to meet deadlines

•Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers

•Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

•Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

•Ability to work in a deadline driven department.

•Excellent verbal and written communication skills

•Ability to abide by Molina’s policies

•Maintain regular attendance based on agreed-upon schedule

•Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

•Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

•Other duties as assigned.

QUALIFICATIONS:

Required Education: 

Bachelor’s Degree in Finance, Computer Science; or equivalent experience

Preferred Education:

Master’s Degree in Finance or Computer Science  

Required Experience:  

  • Expert knowledge on SQL, SSRS and SSIS or similar tools
  • Five or more years of progressive responsibilities in Data, Finance or Systems Analysis

Preferred Experience:

  • Healthcare Payer industry experience
  • Multiple data systems and models
  • BI tools (ProClarity, MEd Insight, etc.)

Preferred Licensure/Certification:

  • QNXT or similar healthcare payer applications   

To all current Molina employees if you are interested in applying for this position please fill out an Employee Transfer Request Form (ETR) and attach it to your profile when ap

Molina Healthcare, a FORTUNE 500 company that is nationally recognized and has grown into one of the leaders in providing quality healthcare for financially vulnerable individuals and families. Molina Healthcare is a multi-state healthcare organization with flexible care delivery systems focused exclusively on government-sponsored healthcare programs for low income families and individuals. Currently, Molina Healthcare arranges for the delivery of healthcare services or offers health information management solutions for nearly 4.3 million individuals and families who receive their care through Medicaid, Medicare and other government funded programs in 15 states. We continually seek talented individuals who share our values and can contribute to our mission of providing the highest quality health care to those who need it most and are least able to afford it. Become part of the Molina Healthcare family today! Discover extraordinary opportunities for growth.

Molina Benefits

Molina offers a variety of career opportunities across the nation as well as excellent compensation and an attractive benefits package that includes.

  • Medical
  • Dental
  • Vision
  • Short- and long-term disability
  • Flexible spending accounts
  • Life insurance plans
  • 401(k) savings plan with employer match
  • Paid time off
  • Paid holidays
  • Volunteer time off
  • Tuition reimbursement
  • Referral bonuses and more!

Molina Healthcare is a Diverse Healthcare Atmosphere & Equal Opportunity Employer (EOE) M/F/D/V.

Job Key Words: Healthcare Analysis, Data, Complex database, data management responsibilities SQL,SSIS, SSRS, ProClarity, MEd Insight, Columbus, Ohio

 

 

 

 

 

To apply, please click here