Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care.

Molina Healthcare 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 offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.

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.

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