Molina Healthcare

Role Description Responsible for accurate and timely intake and interpretation of regulatory and/or functional requirements related to but not limited to coverage, reimbursement, and processing functions to support systems solutions development and maintenance. This role includes coordination with stakeholders and subject matter experts on partnering teams and supporting governance committees where applicable. - Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes to ensure alignment to regulatory baseline requirements and any health plan developed requirements. - Monitors sources to ensure all updates are aligned. - Leads coordinated development and ongoing management/interpretation review process, committee structure and timing with key partner organizations. - Conducts analysis to identify root cause and assist with problem management as it relates to state requirements. - Communicates requirement interpretations and changes to health plans/product team and various impacted corporate core functional areas for requirement interpretation alignment and approvals as well as solution traceability through regular meetings and other operational process best practices. - Provides support for requirement interpretation inconsistencies and complaints. - Self-organized reporting to ensure health plans/product team and other leadership are aware of work efforts and impact for any prospective or retrospective requirement changes that can impact financials. - Engages with operations leadership and Plan Support functions to review compliance-based issues for benefit planning purposes. Qualifications - At least 2 years of experience in previous roles in a managed care organization, health insurance or directly adjacent field, or equivalent combination of relevant education and experience. - Policy/government legislative review knowledge. - Strong analytical and problem-solving skills. - Robust knowledge of Office Product Suite including Word, Excel, Outlook and Teams. - Previous success in a dynamic and autonomous work environment. Requirements - Project implementation experience. - Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). - Medical Coding certification. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance. Qualifications - At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience. - Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity. - Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules. - Strong data analysis/queries experience, and ability to analyze data to inform business decisions. - Strong business judgment, cross-functional coordination, and ownership of high-value deliverables. - Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment. - Strong written and verbal communication skills, including ability to synthesize complex information. - Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency. - Claims processing background. - Experience with Medicare, Medicaid, and/or Marketplace lines of business. - Payment integrity (PI) programs. Requirements - Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery. - Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives. - Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight. - Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies. - Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals. - Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries. - Analyzes data to identify and develop new recovery opportunities. - Conducts peer reviews of recovery concepts and offers recommendations for logical improvements. - Responsible for documenting policies and procedures related to concept approvals. - Conducts trainings and prepares training documentation for teams. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Collects, validates, analyzes, and organizes data into meaningful reports for management decision making as well as designing, developing, testing, and deploying reports to provider networks and other end users for operational and strategic analysis. - Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. - Provides technical expertise, manages relationships with operational leaders and staff. - Directs staff assigned to their projects, maintains internal work plans as well as project work plans to meet reporting needs of the Health Plan. - Acts as a resource to HCS staff for mentoring, coaching, and analysis questions. - Responsible for staff time keeping, performance coaching, development, and career paths. - Daily management of Healthcare Analytics team. - Allocates new report/project requests (workload distribution). - Coordinates with Health Plan departments to meet data analysis and database development needs. - Reviews, evaluates, and improves Company business logic and data sources. - Reviews Health Plan analyst work products to ensure accuracy and clarity. - Reviews regulatory reporting requirements and Health Plan project documentation. - Maintains reporting service level benchmarks for Healthcare Analytics team. - Represents Healthcare Analytics department in cross-departmental and operational meetings. - Serves as liaison between Corporate IT and Health Plan regarding reporting needs. - Creates reporting for strategic analysis, profitability, financial analysis, utilization patterns, and medical management. - Interfaces and maintains positive interactions with Health Plan and Corporate personnel. - Management of Health Plan Encounter workflow process. Qualifications - Bachelor's Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field. - 3 years management or team leadership experience. - 10 years’ work experience preferable in claims processing environment and/or healthcare environment. - Strong knowledge of SQL 2005/2008 SSRS report development. - Familiar with relational database concepts, and SDLC concepts. Requirements - Masters' Degree in Finance, Economics, Math, Computer Science, Information Systems, or related field (preferred). - 3 – 5 years supervisory experience (preferred). Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Leads and directs team responsible for configuration activities including accurate and timely implementation and maintenance of critical information on claims databases, validation of data stored on databases, and adherence to health plan business and system requirements as it pertains to contracting, benefits, prior authorizations, fee schedules and other business requirements. - Directs configuration team, and demonstrates accountability for team performance - including meeting or exceeding established performance targets; targets may be based upon specific health plan requirements, and/or federal/state requirements. - Strategically plans, leads, and manages configuration workflow processes. - Continuously identifies and executes opportunities for operational efficiencies and develops best practice approaches for assigned operational areas, ensuring achievement of organizational/department goals. - Ensures appropriate resources are available to achieve department goals - escalates resource needs, rationale, and deficiencies to leadership. - Identifies and implements strategic process improvements related to the configuration function that demonstrate return on investment (ROI). - Establishes and maintains benefits, provider contracts, fee schedules, claims edits, and other system settings in the claim payment system. - Directs the development and implementation of contract, benefit configuration, and fee schedules. - Directs the implementation and maintenance of member benefits in the claims payment system and other applicable systems. - Supports critical business strategies by providing systematic solutions and or recommendations on business processes. - Plans for long-term success of the department and individual health plans - focusing on goals and improvements to daily operations. - Builds and maintains strong trusted relationships with key stakeholders including health plan leadership and other cross-functional departments; presents data and opportunities to stakeholders and collaborates on performance improvement initiatives. - Coordinates activities of assigned work function and/or department related activities ensuring efficiency and prioritization. - Utilizes superior judgement in evaluating various approaches to limit risk, and communicates risk accordingly to appropriate stakeholders. - Ensures appropriate follow-up and communication occurs on direct assignments, and activities and tasks that fall within the scope of configuration. - Ensures team compliance with applicable federal/state regulations and internal policies/procedures. - Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of configuration/department-specific goals. Qualifications - At least 8 years of configuration oversight, claims, auditing, and/or health care operations experience in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. - At least 3 years of management/leadership experience. - Advanced understanding of claims processes. - Advanced ability to identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources. - Strong analytical, critical-thinking, and problem-solving skills. - Strong multitasking ability, and decision-making skills. - Flexibility to meet changing business requirements, and strong commitment to high-quality/on-time delivery. - Ability to work cross-collaboratively in a highly matrixed organization. - High attention to detail. - Excellent verbal and written communication skills. - Microsoft Office suite proficiency, including advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. Preferred Qualifications - Certified Professional Coder (CPC). - Extensive experience leading analysis and operational teams in a managed care setting. - Extensive experience collaborating with various levels of leadership in a highly matrixed organization. - Deep claims system processing, configuration, and queries experience. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides support to Molina functional areas through program management, including: - Policy, workflow and process documentation - Management of program controls, vendor practices, budgets, governance frameworks, playbooks and best practices - Champion networks, as applicable Responsible for ensuring well-documented: - Policies - Workflows - Program controls - Internal and third-party practices - Playbooks and best practices for respective program - Manages program budget, as applicable, supporting project prioritization - Collaborates with leadership on projects that support Quality compliance with regulatory and accreditation efforts - Acts as the primary liaison between internal departments (e.g., CA Quality, MHI Quality, Healthcare Services, Government Contracts, Network, Compliance, etc.) to ensure policies, procedures, and workflows align with NCQA requirements - Evaluates and interprets accreditation guidelines at least annually, monitoring performance metrics (HEDIS, CAHPS) to ensure compliance with standards - Prepares and submits necessary documentation, reports, and evidence of compliance for regulatory compliance and NCQA accreditation - Tracks performance metrics and ensures value realization from deployed solutions - Coordinates recurring meetings to support governance framework and decision-making processes, as needed - At the direction of program (CoE, Shared Service or other functional area) leadership, supports portfolio management and/or initiative-specific change and project management - Collaborates with key stakeholders to support dissemination and adoption of program guardrails, processes, best practices and other collateral - Routinely reviews program collateral to ensure current and accurate reflection of business needs - Identifies opportunities/gaps and provides recommendations on program enhancements to respective leadership team - Responsible for creating business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations - Generates and distributes standard reports on schedule Qualifications - At least 4 years of Program and/or Project management experience, or equivalent combination of relevant education and experience - Operational Process Improvement experience - Managed Care experience, preferably in a shared service, CoE or matrixed environment - Experience with Microsoft Project and Visio - Strong presentation and communication skills - Understanding of NCQA Accreditation standards, HEDIS, CAHPS and state regulatory requirements (DHCS, DMHC) - Strong project management skills, including ability to manage timelines, facilitate meetings and communicate changes in NCQA accreditation standards and state regulations - Proficient in Microsoft Office Benefits - Molina Healthcare offers a competitive benefits and compensation package

Role Description The Sr Health Educator is responsible for developing, implementing, and maintaining Health Plan Health Education programs. Oversees and assists providers in meeting health education contract requirements and serves as a resource for other Health Educators. The role ensures the maintenance of programs for members is in accordance with prescribed quality standards, including conducting data collection, reporting, and monitoring. We are seeking a professional, Certified in Pediatric Oncology/Hematology. Please make sure to include any certifications or experience on your resume. Job Duties - Develops, implements, and evaluates health education programs for members within the Molina network and the broader community. - Provides oversight and assistance to providers in meeting health education contract requirements. - Serves as a resource for Health Educators in the resolution of issues that may arise during the implementation of Quality Improvement (QI) interventions. - Identifies, designs, implements, and evaluates health education interventions to meet the needs of the targeted population based on priorities established by the department and current contracts. - Conducts population-, geographic-, and member-specific needs assessments. - Coordinates the health education services assessment of IPAs and medical groups as required and collaborates with other QI staff on oversight. - Functions as a liaison to internal departments, community-based organizations, social service agencies, and public health departments as assigned to ensure that Molina resource information is current and available. - Participates in the development of internal resources, in collaboration with others as identified within the annual work plan. - Reviews and updates materials and programs as needed, including preventive care guidelines, incentive packets, Molina Healthcare Plan website, and provider communications. - Successfully engages members in health promotion via direct member calls. - Coordinates care of members from call tracking boxes and Health Education voicemail, including connecting members to appropriate programs and resources. - May work with various grant recipients, state and local entities that aim to improve the health of Molina members, such as STEPS, the WISE Grant, and Healthy People–Healthy Communities. - Participates in QI planning and project work to further QI goals (e.g., HEDIS activities, strategic planning, and special projects). - Provides input on the design and functionality of all utilized databases. - May serve as the Molina Healthcare QI representative at various external activities, including Immunization, EPSDT, Chronic Condition Collaborative, and other work group meetings as assigned. - Demonstrates flexibility when it comes to changes and maintains a positive outlook. Qualifications - Bachelor of Science in Health Education, Health Promotion or Public Health or Associate's Degree in health-related area plus a certification of specialization in patient education (e.g., Certified Diabetes Educator). - 3-5 years’ experience in Health Education with at least 1 year experience working with a wide range of populations within a managed care setting. - Adaptability and flexibility to change/ responsive to new ideas and approaches. - Excellent written, verbal and presentation skills. - Strong organizational skills. - Proficiency in Microsoft Office. - Has excellent problem-solving skills. Preferred Qualifications - Certified Health Education Specialist (CHES). - Knowledge of the Medicaid population. - Knowledge of social support systems, resources and community based and public agencies in the counties of operation. - Pediatrics experience. - Disease Management. - Certified Asthma Educator. Benefits Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Designs, develops, and communicates technology models and foundations used to run applications, data, and infrastructure in support of one or more business processes. Applies and promotes key principles (e.g. stability, scalability, performance, security, compatibility, re-use), helping ensure a balance between tactical and strategic technology solutions. Considers business problems “end-to-end”: including people, process, and technology, both within and outside the enterprise, as part of any design solution. Promotes use of industry and enterprise technology standards. Monitors emerging technologies for potential application within or across the Corporation. Adheres to design and application development standards, methodology and, framework within Architectural compliance and governance. Qualifications - Develops software (hands on code development) to meet key business objectives - Understands and applies SW and applications development methodologies in adherence to SW development standards - Designs and develops SW applications or systems solving specific business or processing problem (Web or Mobile) - Gathers business requirements and develops conceptual design and technical design for multiple projects concurrently - Reviews computer system capabilities, work flow and scheduling limitations to determine if requested program or program change is possible within existing system - Conducts peer review of other developers (internal and contract staff) to ensure standards and quality - Provides guidance, performs code reviews and ensure quality deliveries for self and application engineers - Participates in build vs. buy evaluation process - Provides architecture and design overview in adherence to SW development standards - Strong understanding of Managed Care Organization (MCO) processes and payer workflows - Strong Experience in Healthcare Interoperability (FHIR, HL7, CCD/C-CDA), including data mapping for healthcare integrations - Proven experience in designing and implementing integration solutions using platforms such as MuleSoft or similar - Experience working with enterprise integration patterns and API-based architectures - Good exposure to data integration and transformation in healthcare ecosystems - Experience with Backend DB’s SQL server, PostgreSQL and data engineering platforms like Databricks - Certification or hands-on experience with Epic Payer Platform and payer-side integrations Requirements - Required Education: Bachelor's Degree in relevant field - Required Experience: 3-5 years Application Development Experience - Preferred Education: Master's Degree in Computer Science or Business Field - Preferred Experience: 5-7 years, Healthcare Industry - Preferred License, Certification, Association: Microsoft Technologies, Mobility and ITIL Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Leads and directs team responsible for government contracts activities. Responsible for development and administration of contracts with state and/or federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations in designated Molina markets. - Leads and directs team responsible for management of regulatory and contractual requirements related to government programs including, but not limited to, Medicaid, Medicare, duals Medicare-Medicaid Program (MMP) and Marketplace, including reviewing and implementing new program requirements and ensuring the plan complies with all health plan contractual and regulatory reporting requirements. - Serves as the lead for health care program contractual and regulatory requirements, including performing the initial assessment and overseeing the implementation of all proposed and new contractual and regulatory standards, and ensuring the plan meets all filing requirements and ad hoc reporting requests in a timely manner and with quality deliverables. - Hires, onboards, trains, develops, mentors and performance manages reporting team of government contracts professionals and demonstrates accountability for team goals/deliverables. - Manages contract renewal activities. - Leads project teams involving staff from across the plan to implement new standards for which the government contracts department is accountable or otherwise involved. - Chairs committees and leads workgroups to carryout assigned responsibilities. - Assesses proposed state laws and regulations to determine potential impact, and provides written reports of findings to requesting plan and or corporate staff. - Develops department staff to serve as product line subject matter experts in research standards and program requirements. - Serves as a key liaison with state health care agencies and regulators. - Coordinates plan responses/reports to state health care agencies, regulators and partners regarding contractual and regulatory issues. - Identifies potential new business and bid opportunities. Qualifications - At least 8 years of experience in Medicaid, Medicare, and/or Marketplace health insurance/government programs, and 5 years of experience in government health programs, or equivalent combination of relevant education and experience. - At least 3 years management/leadership experience. - Strong knowledge of Medicaid, Medicare, Marketplace and/or other government-sponsored programs and program compliance. - Ability to work cross-functionally in a highly matrixed environment. - Strong interpersonal skills. - Strong organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Analytical reasoning ability and detail orientation. - Proficient in compiling data, creating reports, and presenting information. - Excellent verbal and written communication skills, including ability to communicate and present to internal and external stakeholders. - Microsoft Office suite and applicable software programs proficiency. Requirements - Legal/compliance-related experience. - Strong Medicaid-specific experience. - Experience with state/federal government relations and relationship building with key governmental representatives. Benefits Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Role Description Leads and directs team responsible for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures. Collaborates with network leadership and the corporate network team to develop and implement standardized provider relationship management and provider services for the health plan. Essential Job Duties - Oversees the plan’s provider relations function and team members. Responsible for the daily operations of the department, including leading and supporting various provider relations activities including provider education, outreach and inquiry resolution. - Develops health plan-specific provider relations strategies - identifying specialties and geographic locations to concentrate resources for the purposes of establishing a sufficient network of participating providers to serve the health care needs of the plan's members, and successfully develop and refine cost-effective and high quality strategic provider networks - ensuring establishment of both internal and external long-term partnerships. - Collaborates with health plan network management and operations teams and functional business unit stakeholders to lead and/or support various provider services functions and strategic initiatives with an emphasis on developing and implementing standards, resources, tools and best practices sharing across the organization. - Develops and deploys strategic network planning tools to drive provider services and contracting strategy across the organization. Facilitates planning and documentation of network management standards and processes for all line of business. - Provides matrix team support including, but not limited to: new markets provider/contract support services, resolution support, and national contract management support services. - Builds and/or facilitates provider communication, training and education programs for internal staff, external providers, and other stakeholders. - Ensures compliance with applicable company/plan business requirements including state/federal statutes, government sponsored program requirements, and network access standards. - Oversees and leads provider representatives activities, including developing and/or presenting policies and procedures, training materials, and reports to meet internal/external standards. - Assists with ongoing provider network development and the education of contracted network providers regarding plan procedures and claims payment policies. - Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards related to provider relations. - Oversees appropriate and timely interventions/communications when providers have issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website). - Serves as a resource to support the plan’s initiatives and helps to ensure regulatory requirements and strategic goals are realized. - Ensures appropriate cross-departmental communication of provider relations initiatives and contracted network provider issues. - Designs and implements programs to build and nurture positive relationships between contracted providers, ancillary providers, hospital facilities and the plan. - Develops and implements strategies to increase provider engagement in Healthcare Effectiveness Data Information Set (HEDIS) and quality initiatives. - Engages contracted network providers regarding cost control initiatives, medical cost ratio (MCR), non-emergent utilization, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) to positively influence future trends. - Develops and implements strategies to reduce member access grievances with contracted providers. - Oversees the integrated health home (IHH) program and ensures IHH program alignment with department requirements, provider education and oversight. - Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. Qualifications - At least 8 years of provider services experience, including experience supporting individual/group providers, hospitals, integrated delivery systems, and ancillary providers with Medicaid, Medicare, and or Marketplace products, or equivalent combination of relevant education and experience. - At least 3 years of management/leadership experience. - Strong understanding of the health care delivery system, including government-sponsored health plans. - Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc. - Previous experience with community agencies and providers. - Strong organizational skills and attention to detail. - Ability to manage multiple tasks and deadlines effectively. - Experience with preparing and presenting formal presentations. - Strong interpersonal skills, including ability to interface with providers and medical office staff. - Ability to work in a cross-functional highly matrixed organization. - Excellent verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications - Contract negotiation experience. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description Provides subject matter expertise consultancy and leadership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. - Extracts and compiles information from various systems to support executive decision-making. - Mines and manages information from large data sources. - Analyzes and researches utilization and unit cost medical cost drivers. - Converts data into usable information - packaging and delivering the results to senior leadership, telling the story through data visualization, collaborates with clinical, provider network and other personnel to bring supplemental context and insight to data analyses. - Provides consultative support and medical cost-based analysis of markets and network initiatives. - Consults with payment integrity, finance and actuarial. - Supports the development of scoreable action items by identifying outlier cost issues. - Performs drill-down analysis to identify medical cost trend drivers; advises network of contracting opportunities to mitigate future trends. - Tracks, documents and takes responsibility for all aspects of related work from beginning to end of a project. - Supports scoreable action item (SAI) initiative tracking to performance. Qualifications - At least 5 years of health care analytics and/or medical economics experience, including experience in the health care/managed care industry and knowledge of provider contracting, provider reimbursement, patient management, product and/or benefits design, or equivalent combination of relevant education and experience. - Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field. - Demonstrated understanding of Medicaid and Medicare programs or other health care plans. - Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) - Proficiency with retrieving specified information from data sources. - Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. - Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) - Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). - Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms. - Understanding of value-based risk arrangements. - Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. - Ability to mine and manage information from large data sources. - Demonstrated problem-solving skills. - Strong critical-thinking and attention to detail. - Ability to effectively collaborate with technical and non-technical stakeholders. - Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications - Experience working with medical and pharmacy claims, authorization data, benefits design, medical management and knowledge of business functions/impact on financials (underwriting, sales, product development, network management). - Proficiency with Power BI and/or Tableau for building dashboards. Benefits - Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.