11 Healthcare Professionals jobs in Post Falls

**JOB DESCRIPTION**
**Job Summary**
Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives.
+ Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business.
+ Must have experience in merger and acquisitions
+ Familiarity with SDLC.
+ Must have strong experience in Jira and smartsheets is preferred
+ Knowledge in Medicare, Medicaid and Marketplace is highly preferred.
+ Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions.
+ Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality.
+ Identifies problems and anticipates potential problems. Ability to present alternatives to manage/overcome obstacles.
+ May consultant with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action. Projects may have moderate cross functional impact and team organization.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required
**Required Experience**
2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable.
**Preferred Education**
Additional formal training in PM preferred.
**Preferred License, Certification, Association**
PMP or Six Sigma Green Belt Certification desired.
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: $77,969 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION

Job Summary

JOB SUMMARY:

The Sr. Analyst, Healthcare plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, care management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions.

JOB DUTIES:

• Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions.

• Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, pharmacy, and lab datasets.

• Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows.

• Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets.

• Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization.

• Ensure data quality, governance, and documentation standards are met in all analytics work.

• Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations.

• Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions.

REQUIRED EDUCATION:

• Bachelor's or Associate's degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields

REQUIRED EXPERIENCE / SKILLS:

• 3-5 years of experience working with healthcare data in an analytics or data engineering capacity

• Advanced proficiency in SQL for large dataset analysis and transformation

• Experience using Power BI for developing interactive dashboards and data visualizations

• Hands-on experience with Databricks , Snowflake , or enterprise cloud data platforms

• Solid understanding of ETL concepts and experience building pipelines for healthcare analytics

• Strong communication and collaboration skills to work with clinical and business stakeholders

PREFERRED EXPERIENCE:

• 4+ years in a healthcare analytics role supporting care management, population health, or quality improvement

• Experience working directly with clinicians, nurses, or case management teams

• Familiarity with risk adjustment, value-based care models, or healthcare performance metrics

• Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling

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: $77,969 - $155,508 / ANNUAL

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

**JOB DESCRIPTION**
**Job Summary**
This position will require an active RN license. Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
**KNOWLEDGE/SKILLS/ABILITIES**
+ In collaboration with others, plans and executes internal Healthcare Services projects and programs involving department or cross-functional teams of subject matter experts, delivering products from the design process to completion.
+ Manages programs providing ongoing communication of goals, evaluation, and support to ensure compliance with standardized protocols and processes.
+ May engage and oversee the work of external vendors.
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business.
+ Serves as a subject matter expert and leads programs to meet critical needs.
+ Communicates and collaborates with customers to analyze and transform needs and goals into functional requirements.
+ Works with operational leaders within the business to provide recommendations for process improvement opportunities.
+ Conducts quality audits to assess Molina Healthcare Services staff educational needs and service quality and implement quality initiatives within the department as appropriate.
+ Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentations.
**JOB QUALIFICATIONS**
**Required Education**
+ Registered Nurse or equivalent combination of Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of RN license.
+ OR Bachelor's or master's degree in Nursing, Gerontology, Public Health, Social Work or related field.
**Required Experience**
+ 5+ years of managed healthcare experience, including 3 or more years in one or more of the following areas: utilization management, case management, care transition and/or disease management.
+ Minimum 2 years of healthcare or health plan supervisory or managerial experience, including oversight of clinical staff.
+ Experience working within applicable state, federal, and third party regulations.
**Required License, Certification, Association**
+ If licensed, license must be active, unrestricted and in good standing.
+ Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
**Preferred Education**
Master's Degree preferred.
**Preferred Experience**
+ 3+ years supervisory/management experience in a managed healthcare environment.
+ Medicaid/Medicare Population experience with increasing responsibility.
+ 3+ years of clinical nursing experience.
**Preferred License, Certification, Association**
Any of the following:
Certified Case Manager (CCM), Certified Professional in Healthcare Management Certification (CPHM), Certified Professional in Health Care Quality (CPHQ), or other healthcare or management certification.
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: $77,969 - $142,549 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
JOB SUMMARY:
The Sr. Analyst, Healthcare plays a critical role in supporting clinical and operational initiatives by translating healthcare business needs into technical solutions. This role works closely with clinicians, care management teams, and business stakeholders to gather requirements and deliver actionable insights through data analytics. The ideal candidate brings a strong foundation in SQL, Power BI, Databricks, Snowflake, and ETL development, along with a collaborative approach to building scalable, healthcare-focused data solutions.
JOB DUTIES:
+ Partner with clinical, operational, and business teams to understand data needs and translate requirements into actionable technical solutions.
+ Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims, pharmacy, and lab datasets.
+ Build and maintain efficient ETL pipelines to support ongoing reporting and analytics workflows.
+ Utilize Databricks and Snowflake to develop scalable data pipelines and analytical datasets.
+ Create and maintain Power BI dashboards to deliver insights on utilization, outcomes, and cost drivers across the organization.
+ Ensure data quality, governance, and documentation standards are met in all analytics work.
+ Support ad hoc data requests and collaborate cross-functionally to drive data-informed decisions in clinical and business operations.
+ Maintain fluency in healthcare data types (e.g., ICD/CPT codes, HEDIS measures, member eligibility) to guide technical decisions.
REQUIRED EDUCATION:
+ Bachelor's or Associate's degree in Data Science, Computer Science, Analytics, Information Systems, Engineering, or other technology-related fields
**REQUIRED EXPERIENCE / SKILLS:**
+ 3-5 years of experience working with **healthcare data** in an analytics or data engineering capacity
+ Advanced proficiency in **SQL** for large dataset analysis and transformation
+ Experience using **Power BI** for developing interactive dashboards and data visualizations
+ Hands-on experience with **Databricks** , **Snowflake** , or enterprise **cloud data platforms**
+ Solid understanding of **ETL concepts** and experience building pipelines for healthcare analytics
+ Strong communication and collaboration skills to work with clinical and business stakeholders
**PREFERRED EXPERIENCE:**
+ 4+ years in a healthcare analytics role supporting **care management, population health, or quality improvement**
+ Experience working directly with **clinicians, nurses, or case management teams**
+ Familiarity with risk adjustment, value-based care models, or healthcare performance metrics
+ Understanding of regulatory and compliance considerations (e.g., HIPAA) in data handling
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: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Overview
At Wipfli, people count.
At Wipfli, our people are core to everything we do-the catalyst behind our ability to create exceptional impact and extraordinary results.
We believe in flexibility. We focus on relationships. We encourage each individual to follow their own path.
People truly matter and they feel it. For those looking to make a difference and find a professional home, Wipfli offers a career-defining opportunity.
This role requires an in-person work arrangement. At Wipfli, in-person work is defined as associates regularly working 5 days a week, for full-time interns, or during your working hours, for part-time interns, in a Wipfli office or at client sites. The client sites can vary locally, regionally, or nationally depending on the industry alignment. Scheduled meetings at the client and in the office require in-person attendance.
Responsibilities
Responsibilities:
Interns will be responsible for utilizing educational knowledge and experience to perform numerous accounting related responsibilities (in audit or financial accounting) such as:
+ Respond to client and firm associate requests in a timely, accurate, positive and professional manner
+ Respond to inquiries from client and work with client to gather necessary information for completion of required documents
+ Use data analysis skills to discover useful information and patterns to provide support in recommendations
+ Proactively identify improvement opportunities in processes to enhance efficiency
Healthcare Audit & Accounting Specific:
+ Perform audit, review, and compliance testing procedures in accordance with firm an professional standards and as directed by engagement leaders
+ Communicate with engagement leaders regarding open items, testing problems, or other important matters in a timely manner
+ Prepare (or review client prepared) financial statements and footnotes, management reports, and other engagement outputs
+ Develop technical competency with GAAP, especially related to assigned product line
+ Assist team with Medicare and Medicaid/Medi-cal Cost Report Reimbursement team!
What You will Gain
+ Experience the Wipfli Way first hand while working side by side with professionals from all levels of the firm
+ Develop experience and skills to become a trusted business advisor for clients and associates
+ Gain hands-on experience in tax and/or audit work, and related software applications
+ Work as an individual contributor and as part of a team to support client engagements
+ Gain exposure to a variety of clients and industries ranging from small businesses to large corporations
+ Develop administrative, professional, and interpersonal skills to the extent of being able to organize, analyze, and communicate with others in a productive and efficient manner
This position will take place starting in August-December 2 026.
Knowledge, Skills and Abilities
Qualifications:
+ Pursuing a Bachelors or Master's degree in Accounting (completion of corporate or individual taxation class is required)
+ Above average knowledge in accounting as demonstrated by college GPA; Preferred 3.0 GPA or higher
+ Working towards eligibility to sit for CPA exam upon graduation
+ Preferred coursework in Data Analytics or Big Data
+ Ability to think independently and make good decisions based on education and experience
+ Good communication and interpersonal skills to effectively communicate with clients and staff
+ Ability to prioritize work, follow through on requests, take initiative and meet deadlines
+ Must be legally authorized to work in the United States on a full-time basis upon hire. Wipfli will not consider candidates for this position who require sponsorship for employment visa status now or in the future (e.g., H-1B status)
Estella Anderson, from our recruiting team, will be guiding you through this process. Visit herLinkedIn ( page to connect!
#LI-Hybrid
#LI-EA1
Additional Details
This role requires an in-person work arrangement. At Wipfli, in-person work is defined as associates regularly working 5 days a week in a Wipfli office or at client sites. The client sites can vary locally, regionally, or nationally depending on the industry alignment. Scheduled meetings at the client and in the office require in-person attendance.
Additional Details:
Not fully prepared to apply for an internship or not sure where to start? Please join our Talent Community to explore how you can stay connected to Wipfli.
Wipfli is an equal opportunity/affirmative action employer. All candidates will receive consideration for employment without regards to race, creed, color, religion, national origin, sex, age, marital status, sexual orientation, gender identify, veteran status, disability, or any other characteristics protected by federal, state, or local laws.
Wipfli is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or participate in our recruiting process, please send us an email at
Wipfli values fair, transparent, and competitive compensation, considering each candidate's unique skills and experiences. The estimated base pay rate for this role is $28/hour. The actual salary at the time of offer depends on business related factors like location, skills, experience, training/education, licensure, certifications, business needs, current associate pay, and relevant employment laws.
Wipfli cares about our associates and offers a variety of benefits to support their well-being. Benefit offerings include paid sick leave; access to free, confidential counseling through our Employee Assistance Program. This role requires a hybrid work arrangement. At Wipfli, hybrid is defined as associates regularly work in a Wipfli office, from home, and other meeting sites. Note that scheduled meetings in the office will require in-person attendance.
Job LocationsUS-WA-Spokane
Job ID 2024-6537
Category Entry-Level/Internships
Remote No

Job Description

Job Summary

Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provider), network management, credentialing, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit interpretation within the audit process. Provide clear and concise results and comments to leaders about focal audits. Contributes to completion of audits as needed to ensure audits are conducted in a timely fashion and in accordance with audit standards.

Job Duties

• Reviews documentation regarding updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these updates/changes as applied to the appropriate modules within the core processing system (QNXT).

• Conducts focal audits on samples of processed transactions impacted by these updates/changes. Determines that all outcomes are aligned to the original documentation and allow appropriate processing.

• Conducts audits of vendor audits and verifies accuracy of their published outcomes are aligned to the documentation, various sources of truth and being assessed appropriately.

• Clearly documents the focal audit results and makes recommendations as necessary.

• Researches and tracks the status of unresolved errors issued on daily transactional audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of error issuance.

• Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. ( Use for claims specific positions only )

• Prepares, tracks and provides audit findings reports according to designated timelines

• Presents audit findings and makes recommendations to management for improvements based on audit results.

Job Qualifications

REQUIRED EDUCATION:

Associate’s Degree or equivalent combination of education and experience

REQUIRED EXPERIENCE, SKILLS & ABILIITIES:

• Minimum 2 years as an operational auditor for at least one core operations function

• Previous examiner/processing experience in at least one core operations functional area

• Strong attention to detail

• Knowledge of using Microsoft applications to include; Excel, Word, Outlook, Powerpoint and Teams

• Ability to effectively communicate written and verbal

• Knowledge of verifying documentation related to updates/changes within claims processing system .

• Experience using claims processing system (QNXT).

PREFERRED EDUCATION:

Bachelor’s Degree or equivalent combination of education and experience

PREFERRED EXPERIENCE:

3+ years

Healthcare Claims Adjudication

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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: $21.16 - $42.2 / HOURLY

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

**Job Description**
**Job Summary**
Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains to contracting (benefit and provider), network management, credentialing, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. Maintain audit records, and provide counsel regarding coverage amount and benefit interpretation within the audit process. Provide clear and concise results and comments to leaders about focal audits. Contributes to completion of audits as needed to ensure audits are conducted in a timely fashion and in accordance with audit standards.
**Job Duties**
- Reviews documentation regarding updates/changes to member enrollment, provider contract, provider demographic information, and/or claim processing guidelines. Evaluates the accuracy of these updates/changes as applied to the appropriate modules within the core processing system (QNXT).
- Conducts focal audits on samples of processed transactions impacted by these updates/changes. Determines that all outcomes are aligned to the original documentation and allow appropriate processing.
- Conducts audits of vendor audits and verifies accuracy of their published outcomes are aligned to the documentation, various sources of truth and being assessed appropriately.
- Clearly documents the focal audit results and makes recommendations as necessary.
- Researches and tracks the status of unresolved errors issued on daily transactional audits and communicates with Core Operations Functional Business Partners to ensure resolution within 30 days of error issuance.
- Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. ( _Use for claims specific positions only_ )
- Prepares, tracks and provides audit findings reports according to designated timelines
- Presents audit findings and makes recommendations to management for improvements based on audit results.
**Job Qualifications**
**REQUIRED EDUCATION:**
Associate's Degree or equivalent combination of education and experience
**REQUIRED EXPERIENCE, SKILLS & ABILIITIES:**
+ Minimum 2 years as an operational auditor for at least one core operations function
+ Previous examiner/processing experience in at least one core operations functional area
+ Strong attention to detail
+ Knowledge of using Microsoft applications to include; Excel, Word, Outlook, Powerpoint and Teams
+ Ability to effectively communicate written and verbal
+ Knowledge of verifying documentation related to updates/changes within claims processing system .
+ Experience using claims processing system (QNXT).
**PREFERRED EDUCATION:**
Bachelor's Degree or equivalent combination of education and experience
**PREFERRED EXPERIENCE:**
3+ years
Healthcare Claims Adjudication
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
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: $21.16 - $42.2 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk score reporting with Databricks and Power BI, organizing and managing large and varied data sets, analyzing healthcare data for decision support, and communicating findings. Qualified candidates are the diligent problem solvers who have Databricks experience with advanced skills in data analysis. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Utilizes Power BI to display relevant reporting within a refresh cycle.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compile and organize health care data using Databricks and Spark SQL programming, Notebooks, Workflows, Repositories, and other analytic / programming processes as needed.
+ Collect programming specifications from requestors to develop Notebooks, Workflows, and Power BI reporting using multiple data sources, crosswalks, and built-in validation checks.
+ Use peer-to-peer review process and end-user consultation to reduce errors and rework.
+ Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps.
+ Must have a strong attention to detail and knowledge of data structure and programming.
+ Understanding data storage and data sharing methods.
+ Converting data into usable information that is easy to understand.
+ Research and develop reports and analysis for senior management and effectively communicate results.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of Databricks
+ Bachelor's Degree in Finance, Economics, Math, or Computer Science
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Experience developing queries within project management tools like Azure DevOps.
+ Risk Adjustment experience and some familiarity with Power BI level report building, leveraging PBI to develop business insights.
+ 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.
+ Analysis and forecasting of trends to provide analytic support for finance, pricing and actuarial functions.
+ Healthcare Analyst I experience desired.
+ PowerBI, Excel, Power Pivot, VBA, Macros, Copilot
+ Python, PySpark, R, SAS, or other programming language(s)
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: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ 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.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
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.
#PJCorp
#LI-AC1
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.