JOB DESCRIPTION
This role will be a member of the Payment Integrity Analytics team who is responsible for creating and maintaining a post pay review of claims, members, and providers to ensure accurate billing. Our team creates Post Pay Concepts (Analytics) that identify inaccurately billed claims with potential overpayments for correction and perhaps reduction of payment. At times we will also build reports and identify insights for tracking operations of running and monitoring these concepts or analytics.
Job Summary
Designs and implements processes and solutions associated with a wide variety of data sets used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables by applying statistical analysis techniques to examine structured and unstructured data from multiple disparate sources. Collaborates across departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods to develop solutions. Develops information tools, algorithms, dashboards, and queries to monitor and improve business performance. Creates solutions from initial concept to fully tested production and communicates results to a broad range of audiences. Effectively uses current and emerging technologies.
KNOWLEDGE/SKILLS/ABILITIES
- With limited supervision, the Sr. Analyst, Data is responsible for data compilation, data management, data analysis, and reporting
- Extracts and compiles various sources of information and large data sets from various systems or applications
- Set up process for monitoring, tracking and trending information and data using various systems or applications
- Prepares well-organized, easily understood reports, analysis, and summary of findings for use by management
- Assists in preparation of regularly produced reports to support executive decision-making
- Researches and analyze report results identifying opportunities and trends
- Works with internal, external and enterprise individuals as needed to research, develop, and document new standard reports or processes
- Consolidates data from multiple sources, using industry-based tools or manually; able to process data effectively using Microsoft Excel
- Supports management and other team members as requested on all things data related.
JOB QUALIFICATIONS
Required Education - Associate degree or equivalent combination of education and experience
Required Experience
3-5 years
- Experience using technical tools such as Databricks or other similar tool, Azure Dev Ops, PowerBI, SQL
- Experience in Agile, Software Development Lifecycles.
- Experience working in a healthcare field is required.
Preferred Education
Bachelor's Degree or equivalent combination of education and experience. Prefer degree in Computational Analytics and Data Science, Computer Science, Statistics, or related field.
Preferred Experience
- 5-7 years’ experience in analytics or healthcare data
- Experience in Payment Integrity, claims auditing, or healthcare cost containment
- Experience working with claims platform data such as QNXT, Facets or similar systems.
- Experience supporting Medicaid, Medicare or Marketplace Lines of Business
- Experience using technical tools such as Python
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.
Skills Required
- Associate degree or equivalent combination of education and experience
- 3-5 years of experience
- Experience using Databricks or similar tools
- Experience with Azure DevOps
- Experience with PowerBI
- Proficiency in SQL
- Experience in Agile and Software Development Lifecycles
- Experience working in a healthcare field
- Proficiency with Microsoft Excel
- Bachelor's degree (preferred)
- 5-7 years' experience in analytics or healthcare data (preferred)
- Experience in Payment Integrity, claims auditing, or healthcare cost containment (preferred)
- Experience with claims platforms such as QNXT or Facets (preferred)
- Experience supporting Medicaid, Medicare or Marketplace lines of business (preferred)
- Experience using Python (preferred)
What We Do
Molina Healthcare Inc. is dedicated to delivering effective, reliable, and affordable health care to those who need it most. The company focuses on improving the health and well-being of its members and positively impacting the communities it serves. Recognized as a leader in the health insurance category, it provides essential healthcare services to ensure accessible and quality care for its members.
