Lead Healthcare Analyst (2891BR) Columbus, Ohio

Job 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.

Essential Functions

• 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.

Knowledge/Skills/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



Required Education: 
• Bachelor’s Degree in Finance, Computer Science; or equivalent experience
                                                                                                         
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
                                                                                                                 
Required Licensure/Certification:N/A
                                                                                                                           
 
Preferred Education:
• Master’s Degree in Finance or Computer Science  
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 apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

To apply, please click here