Network specialist serp_jobs.h1.location_city

Job Description

Job Summary

Sr. Analyst, Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality care with improved outcomes through better coordination and preventive care and develop payment strategies that give incentives to providers and healthcare systems that deliver better health, more affordably.

Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care models.

Knowledge / Skills / Abilities

Develop key strategic reports and analysis using SQL programming, SQL Server Analytic Services (SSAS), Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard.

Generate hospital performance analytics tools on a quarterly basis; develop reports on a regular basis using SQL, Excel, and other reporting software.

Research, develop, analyze and recommend cost savings opportunities in alignment to support enterprise strategies

Track, monitor, and report cost savings initiatives (hospitals, physicians, ancillary) trend analyses, and its performance on a monthly basis.

Conduct financial modeling and analysis (including trend analysis) by utilizing NetworX Modeler and ETL systems to support negotiating strategies, modeling current and future contract rate proposals.

Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate / consult the health plans on the financial impact.

Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting

Ability to translate contract rates and terms to evaluate the financial impact to effectively negotiate new or amended contracts (e.g. coding and chargemaster impact analysis)

Strong written and verbal communication skills required to present analytical results and findings to healthplans' senior management team and key stakeholder meetings (PowerPoint)

Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ensure timely deliverables to stakeholders requiring decision support.

Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings.

Provides peer review of pricing configuration to ensure accuracy of financial modeling

Provides peer review of team members' presentations for total cost of care and profit improvement initiatives

Support process improvements for the team's methods of collecting and documenting report / programming requirements

Serves as a key resource on the more complex pricing and analysis issues

Reviews work performed by others and provides recommendations for improvement.

Job Qualifications

Required Education

• Bachelor's Degree in Business, Finance, Mathematics, Economics, Data Science or Actuarial Sciences or equivalent experience

Required Experience

healthcare economics or related discipline.

5+ years increasingly complex database and data management responsibilities

Advanced level proficiency in Microsoft Excel

Intermediate to advanced level proficiency in SQL

5+ years of increasingly complex experience in quantifying, measuring, and analyzing financial / performance management metrics

Required License, Certification, Association

N / A

Preferred Education

Master's Degree

Preferred Experience

Preferred experience in healthcare medical economics and / or strong financial analytics background

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.

Experience with industry standard normalization / reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)

Preferred License, Certification, Association

N / A

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.

Pay Range : $77,969 - $129,590 / ANNUAL