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.