Senior Analyst, Medical Economics

Senior Medical Economics Analyst – Drive Healthcare Affordability and Innovation

Are you a data-driven problem-solver passionate about optimizing healthcare costs and improving patient outcomes? Molina Healthcare is seeking a highly skilled Senior Medical Economics Analyst to join our dynamic team. In this role, you will be a key contributor to our Health Plan and Finance teams, providing insightful analysis and strategic recommendations to drive affordability and enhance the overall performance of our healthcare products.

What You’ll Do:

As our Senior Medical Economics Analyst, you’ll be at the forefront of healthcare innovation, utilizing your analytical prowess to:

• Uncover Cost Drivers: Analyze complex healthcare data to identify the root causes of medical cost trends and develop strategies to mitigate them.
• Develop Actionable Insights: Design and build comprehensive reports and dashboards to monitor health plan performance and track key performance indicators (KPIs).
• Drive Affordability Initiatives: Create and implement tools to monitor trend drivers and provide data-backed recommendations to senior leadership for affordability opportunities.
• Collaborate Cross-Functionally: Partner with clinical, provider network, and other teams to gain a holistic understanding of data analyses and design studies to quantify the impact of medical interventions.
• Estimate Financial Value: Perform pro forma sensitivity analyses to estimate the expected financial value of proposed medical cost improvement initiatives.
• Communicate Effectively: Present complex data and analyses in a clear and concise manner to audiences at various levels of the organization.
• Stay Ahead of the Curve: Remain informed about Medicaid and Medicare reforms and their potential impact on Molina Healthcare.

Your Responsibilities Will Include:

• Extracting, compiling, and analyzing data from various sources to support executive decision-making.
• Mining and managing information from large data sources to identify risks and opportunities.
• Analyzing claims and other data sources to identify early signs of trends or other issues related to medical care costs.
• Developing financial models to evaluate the impact of provider reimbursement changes.
• Supporting Medical Management by assisting with Return on Investment (ROI) analyses for vendors.
• Providing data-driven analytics to Finance, Claims, Medical Management, Network, and other departments.

What You’ll Bring:

We are looking for a highly motivated and experienced individual with the following qualifications:

• Education: Bachelor’s Degree in Mathematics, Economics, Computer Science, Healthcare Management, or a related field.
• Experience: 5+ years of analytical experience in the healthcare industry (e.g., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization).
• Knowledge: Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans.
• Technical Skills:
  • Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
  • Proficiency with Excel and SQL for retrieving specified information from data sources.
  • Experience with building dashboards in Excel, Power BI, and/or Tableau and data management
• Healthcare Operations: Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.).
• Financial Acumen: Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.).
• Managed Care Expertise: Demonstrated understanding of key managed care concepts and provider reimbursement principles (e.g., risk adjustment, capitation, FFS).
• Analytical Skills: Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare.
• Data Management: Ability to mine and manage information from large data sources.

Bonus Points:

• Proficiency with Power BI and/or Tableau for building dashboards.
• Experience with Databricks and TOAD Data Point.

Join Our Team!

If you are a passionate and results-oriented Senior Medical Economics Analyst looking to make a significant impact on the healthcare industry, we encourage you to apply! Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer (EOE) M/F/D/V.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.