Healthcare Analyst II

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Job SummaryHealthcare Analyst II is an individual contributor role that provides senior-level healthcare analysis for the state health plans, including quantification and analysis of health care costs, development and maintenance of databases and other sources of information for quality initiatives, accreditation efforts, and regulatory mandates, and claims data coordination.Essential Functions* Implement and use software and systems to support the department's goals.* Create new databases and reporting tools for monitoring, tracking and trending based on project specifications.* Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.* Responsible for timely completion of projects, including timeline development and maintenance, and coordination of activities and data collection with requesting internal departments or external requestors.* Establish and maintain positive working relationships with internal customers and external vendors, including individuals who are supervised by others.* Provide leadership to other members of the team, including training of Healthcare Analyst I level personnel and internal customers. State Plan / Department Specific Duties and Responsibilities * Ability to practice Service Excellence (Molina Texas)Knowledge/Skills/Abilities* Ability to manage various sources of information and large data sets including pharmacy, claims and encounter data* Proficiency in compiling data, creating reports and presenting information, including expertise with Crystal Reports (or similar reporting tool), SQL query, MS Access and MS Excel* Ability to combine clinical and financial data* Demonstrated ability to meet established deadlines* Ability to function independently and manage multiple projects* Ability to develop scenario analysis using different approaches* Ability to present ideas and information concisely to varied audiences* Proficiency with PC-based systems, and the ability to learn other systems through knowledge of MS Excel and Access* Excellent verbal and written communication skills* Ability to abide by Molina's policies* Ability to maintain attendance to support required quality and quantity of work, yet be flexible enough to work off-hours to meet deadlines* Ability to quickly assimilate knowledge of processes and systems to develop and deliver necessary training to departmental staff and internal customers* Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)* Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers* Ability to work in a deadline driven departmentRequired Education: Bachelor's Degree; or combination of relevant education and experience Required Experience: 4 years increasingly complex database and data management responsibilitiesBasic knowledge of SQL Required Licensure/Certification: Preferred Education:Bachelor's Degree in Math, Finance, Business or IS Preferred Experience:* Healthcare Payer industry experience* Healthcare Analyst I or Financial/Accounting Analyst I experience desired* Multiple data systems and models* BI tools Preferred Licensure/Certification: state specific job description:• Coordinates the preparation of the annual HEDIS medical record review project which includes Chase MOCK refinement, test run and analysis.• Collaborates with other staff in Missed Services Report production.• Assists Manager in annual NCQA Roadmap preparation.• Conducts data extraction, validation and analysis. • Assists in the Medical Record collection process including making phone calls to providers if assigned by manager.• Assists in the preparation of the annual HEDIS Compliance audits.• Works with the corporate HEDIS team to monitor accuracy of data and methodologies when assigned.• Participates in meetings with vendors for Medical Record Collection process. • Assists manager in on-going physician and member interventions and incentive efforts as needed.• Participates in scheduled meetings with the corporate HEDIS team and vendors, HEDIS auditors.• Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS, state audits.To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.