Dir, Network Strategy, Pricing & Analytics Job at Molina Healthcare
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
Provide guidance and strategic direction to a team of Network Strategy, Pricing & Analytics professionals to support health plan management of unit cost budget.
Provide SME analysis support to keep senior management and health plan management aware of potential unit cost risks & opportunities.
Responsible for all aspects of financial modeling, reporting and analysis including developing data structures and maintaining ETL systems to facilitate provider unit cost analysis & trends and recommend cost-savings initiatives in a meaningful way.
Responsible for fee schedule implementation including: monitoring, preparation, quality control, and financial impact modeling of all changes to Federal and State reimbursement methodologies as well as provider contract updates.
Assess the accuracy of provider reimbursements, including claims, capitation, and incentive payments; address queries from internal and external stakeholders; analyze fluctuations in provider reimbursement amounts; drive process improvement to maximize financial results; oversee the collection and analysis of information; summarize trends; prepare special financial reports regarding provider disbursements.
Actively engage in management activities within the department but not limited to hiring, training, managing, and evaluating Network Strategy, Pricing and Analytics staff.
Recruit, select, orient, and train employees in order to maintain staff to meet objectives. Provide information, educational opportunities, and experiential growth opportunities in order to develop staff. Plan performance expectations, monitor, and appraise the analyst's job results and performance.
Oversee 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.
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)
Excellent 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
10+ years of analytics experience in financial analysis, healthcare pricing, network management, healthcare economics or related discipline.
10+ years increasingly complex database and data management responsibilities
10+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metric
5+ years managing staff and mentoring/leading a team of analysts
Advanced to expert level proficiency in Microsoft Excel
Advanced level proficiency in Access and/or SQL
Functions as subject matter expert on finance and healthcare analytics topics. Able to teach financial/technical information.
Required License, Certification, Association
N/A
Preferred Education
Master's Degree in Business, Finance, Mathematics or Economics or Actuarial Sciences
Preferred Experience
5 – 7 years of supervisory experience leading healthcare analytics function
Preferred experience in healthcare medical economics and/or expert financial analytics background
Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)
Medical Economics and/or advanced Healthcare Financial Analytics background
Demonstrated knowledge of Value-Based Programs (VBP) including shared savings, bundled payments, pay-for-performance, and capitation
Experience in VBP modeling, including expected and actual revenues/volumes, past performance, proposed contract language, risk adjustment and regulatory changes
Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement methodologies
Ability to effectively present complex analytic models/results to leadership, and other key stakeholders, for review and decision-making
Preferred License, Certification, Association
N/A
Pay Range: $97,299 - $189,732 a year*
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Please Note :
epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.
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
Provide guidance and strategic direction to a team of Network Strategy, Pricing & Analytics professionals to support health plan management of unit cost budget.
Provide SME analysis support to keep senior management and health plan management aware of potential unit cost risks & opportunities.
Responsible for all aspects of financial modeling, reporting and analysis including developing data structures and maintaining ETL systems to facilitate provider unit cost analysis & trends and recommend cost-savings initiatives in a meaningful way.
Responsible for fee schedule implementation including: monitoring, preparation, quality control, and financial impact modeling of all changes to Federal and State reimbursement methodologies as well as provider contract updates.
Assess the accuracy of provider reimbursements, including claims, capitation, and incentive payments; address queries from internal and external stakeholders; analyze fluctuations in provider reimbursement amounts; drive process improvement to maximize financial results; oversee the collection and analysis of information; summarize trends; prepare special financial reports regarding provider disbursements.
Actively engage in management activities within the department but not limited to hiring, training, managing, and evaluating Network Strategy, Pricing and Analytics staff.
Recruit, select, orient, and train employees in order to maintain staff to meet objectives. Provide information, educational opportunities, and experiential growth opportunities in order to develop staff. Plan performance expectations, monitor, and appraise the analyst's job results and performance.
Oversee 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.
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)
Excellent 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
10+ years of analytics experience in financial analysis, healthcare pricing, network management, healthcare economics or related discipline.
10+ years increasingly complex database and data management responsibilities
10+ years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metric
5+ years managing staff and mentoring/leading a team of analysts
Advanced to expert level proficiency in Microsoft Excel
Advanced level proficiency in Access and/or SQL
Functions as subject matter expert on finance and healthcare analytics topics. Able to teach financial/technical information.
Required License, Certification, Association
N/A
Preferred Education
Master's Degree in Business, Finance, Mathematics or Economics or Actuarial Sciences
Preferred Experience
5 – 7 years of supervisory experience leading healthcare analytics function
Preferred experience in healthcare medical economics and/or expert financial analytics background
Experience with industry standard normalization/reimbursement methodologies (APR-DRG, MS-DRG, EAPG, APC)
Medical Economics and/or advanced Healthcare Financial Analytics background
Demonstrated knowledge of Value-Based Programs (VBP) including shared savings, bundled payments, pay-for-performance, and capitation
Experience in VBP modeling, including expected and actual revenues/volumes, past performance, proposed contract language, risk adjustment and regulatory changes
Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement methodologies
Ability to effectively present complex analytic models/results to leadership, and other key stakeholders, for review and decision-making
Preferred License, Certification, Association
N/A
Pay Range: $97,299 - $189,732 a year*
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Please Note :
epokagency.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, epokagency.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.