Molina Healthcare

Lead Analyst, HEDIS Healthcare Analytics

Molina Healthcare$90K — $120K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Finance, Economics, or Computer Science.
  • 6+ years in Data, Finance, or Systems Analysis with progressive responsibilities.
  • Expertise in SQL, SSRS, and SSIS or similar tools.
  • Preferred: Experience in Medical Economics and Performance Indicators.
  • Familiarity with BI tools like ProClarity and Med Insight.

Responsibilities

  • Perform complex research and analysis of healthcare claims and costs.
  • Generate ad-hoc reports using advanced SQL and analytic tools.
  • Coordinate report generation and oversee quality assurance.
  • Guide development of predictive models for cost and utilization trends.
  • Implement process improvements for report creation and documentation.
  • Manage workflows for report production and distribution.
  • Assist with special projects supporting regulatory and contracting requirements.

Benefits

  • Comprehensive health insurance options.
  • Retirement savings plans.
  • Career development and training opportunities.
  • Employee wellness programs.
  • Flexible working conditions.
Full Job Description
Job Description

JOB DESCRIPTION

Job Summary

Performs research and analysis of complex HEDIS healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

KNOWLEDGE/SKILLS/ABILITIES
  • Develops, implements, and uses software and systems to support the department's goals.
  • Develops and generates ad-hoc and standard reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools.
  • Coordinates and oversees report generation by team members and distribution schedule to ensure timely delivery to customers, ensuring the highest quality on every project/request. Responsible for error resolution, follow up and performance metrics monitoring.
  • Provides peer review of critical reports and guidance on programming / logic improvements; provides guidance to team members in their analysis of data sets and trends using statistical tools and techniques to determine significance and relevance.
  • Participate in and guide the design of large scale predictive and statistical models to predict future trends in cost, utilization, and performance. Guide team members on appropriate writing skills for executive summaries tailored to the audience.
  • Applies process improvements for the team's methods of collecting and documenting report / programming requirements from requestors to ensure appropriate creation of reports and analyses while reducing rework.
  • Manage the creation of comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
  • Create new databases and reporting tools for monitoring, tracking, and trending based on project specifications.
  • Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures.
  • Assist 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.
  • Maintains SharePoint Sites as needed, including training materials and documentation archives.
  • Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience
  • 6+ years of progressive responsibilities in Data, Finance or Systems Analysis
  • Expert knowledge on SQL, SSRS and SSIS or similar tools

Preferred Education

Bachelor's Degree in Finance, Economics, Math, or Computer Science

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
  • 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.
  • Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing, and actuarial functions
  • Multiple data systems and models
  • BI tools (ProClarity, MEd Insight, etc.,)

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

Azure and Databricks

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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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