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Job Information

Molina Healthcare Lead Business Analyst (Encounters) in Cincinnati, Ohio

JOB DESCRIPTION

Job Summary

Supporting the OH Plan, the candidate will act as a liaison to our state regulator on Encounters as well as lead various other technical programs under the OH Operations Department. These currently include support of provider data requirements, vendor data interfaces, Ohio Dept of Medicaid data interfaces, and be a technical resource that can liaison between OH Operations Dept and IT teams. Must be a self-starter willing to learn. Must be a good communicator, comfortable speaking up in group discussions and love work collaboratively with other teams and with senior leadership. This role involves research, root cause analysis, sharing recommendations, analyzing reports and other duties as specified.

Analyzes complex business problems and issues using member, provider, claims, and encounter data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with clients to modify or tailor existing analysis or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. May be internal operations-focused or external client-focused.

KNOWLEDGE/SKILLS/ABILITIES

  • Develops, implements and uses software and systems to identify issues in data sourced from state and federal agencies and loaded to internal systems.

  • Identify data trends.

  • Good knowledge of EDI X12 Transactions such as 834, 835, 837, etc.

  • Uses comprehensive background to navigate analytical problems, including clearly defining and documenting their unique specifications.

  • Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.

  • Responsible for developing appropriate methodologies and preparation of weekly reports.

  • Encourages cooperative interactions between cross functional teammates.

  • Coordinates work of other business data analysts and provides training to subordinates/team members.

  • Leverages expertise to review, research, analyze and evaluate all data relating to specific area of expertise.

  • Actively leads in all stages of project development including research, design, programming, testing and implementation to ensures the released product meets the intended functional and operational requirements

  • Uses mastery of subject matter to guide communication and collaboration with external and internal customers by analyzing their needs and goals.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

  • 7+ years of business analysis experience,

  • 6+ years managed care experience.

  • Demonstrates expertise in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Preferred Education

Graduate Degree or equivalent combination of education and experience

Preferred Experience

  • 6+ years experience working as a data or business analyst

  • Experienced in developing ad-hoc and standard reports using SQL and Azure Databricks or similar tools to perform analysis on member enrollment data

  • 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.

Preferred License, Certification, Association

QNXT or similar healthcare payer applications

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: $59,810.6 - $129,589.63 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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