Job Description
Job Summary
Responsible for supporting and validating Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting. Perform financial modeling to support well-informed negotiations, anticipating issues resulting in the ability to reach contract terms with good faith with sustainability.
Knowledge/Skills/Abilities
- Manage provider pricing analysis including overseeing staff analysts' duties & responsibilities to support health plan management of unit cost budget. Reviews and updates necessary material to keep senior management and health plan management aware of potential unit cost risks & opportunities
- Manage reporting in areas of provider unit cost performance and unit cost management. Performs analyses related to unit cost trends and is proactive in recommending risks and opportunities.
- Engages in management activities within the department but not limited to hiring, training, managing, and evaluating Network Pricing and Analytics staff.
- Recruit, manage, and develop a team of analysts in a matrix reporting environment.
- Contract pricing: financial modeling of provider contracts (e.g. Medicaid, Medicare, CFAD, HIX, ACA Primary Care Enhancements, National/Ancillary, capitation, fee-for-service hospital reimbursement, P4P)
- Support Unit Cost Trend Tracking and Reporting including Quarterly Top 20 Dashboard and Network Management Metric Dashboard
- Build strong inter-dependent relationships within the organization as appropriate, including Corporate Actuary, Utilization Management, Health Plan Finance and Network Management & Operations.
- Work with Contract Leads in Network Management & Operations enterprise wide to identify unit cost savings opportunities in conjunction with network requirements
- Partner with Contract Leads in Network Management & Operations enterprise wide to achieve unit cost targets and contracting initiatives
- Anticipate client needs and proactively develop solution to meet them
- Serve as a key resource on complex/and/or critical issues
- Solve complex problems and develop innovative solutions
- Perform complex conceptual analyses
- Review work performed by others and provide recommendation for improvement
- Forecast and plan resource requirements
- Provide expansions and information to others on the most complex issues
- Develop key strategic reports and analysis using SQL programming, SQL Server Analytic Services (SSAS), Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard
- 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)
- 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
- 7+ years of analytics experience in financial analysis, healthcare pricing, network management, healthcare economics or related discipline.
- 7+ years increasingly complex database and data management responsibilities
- 7+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metric
- 2+ years managing staff or mentoring/leading a team of analysts
- Advanced to expert level proficiency in Microsoft Excel
- Advanced level proficiency in Access and/or SQL
Preferred Education
- Master's Degree in Business, Finance, Mathematics or Economics or Actuarial Sciences
Preferred Experience
- Preferred experience in healthcare medical economics and/or advanced financial analytics background
- Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)
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.
Working at
Molina Healthcare
Molina Healthcare is a leading managed healthcare company dedicated to providing quality healthcare services to underserved communities. With a strong commitment to improving access to care, Molina Healthcare offers a wide range of health insurance plans and solutions. As an actuary at Molina Healthcare, you'll play a crucial role in assessing and managing risks to ensure the financial stability of the company's healthcare offerings. Actuaries at Molina Healthcare utilize their expertise in statistical analysis and risk assessment to develop pricing strategies, analyze healthcare trends, and provide insights that support evidence-based decision-making. Molina Healthcare's focus on serving vulnerable populations and providing cost-effective care creates unique challenges and opportunities for actuaries. Collaborating with cross-functional teams, actuaries at Molina Healthcare analyze complex healthcare data, identify trends, and develop innovative solutions that improve health outcomes while managing costs. Professional growth is highly valued at Molina Healthcare, and actuaries have access to ongoing training and development opportunities. Actuaries can enhance their skills and expertise while contributing to the company's mission of providing quality healthcare to those who need it most. Join Molina Healthcare's esteemed actuarial team and embark on a fulfilling career where you can make a meaningful impact on underserved communities, drive healthcare innovation, and enjoy a supportive work environment.