clopez
Networker
Molina Healthcare Special Investigation Unit has an open position for Data Analyst, if intereseted and meet the qualifications please go to Molina Healthcare careers and search for job positing 21165BR or email resume to cindy.lopez1@molianahealthcare.com
Posting Title: SIU Data Analyst
State and City: CA-Long Beach
State: California (CA)
Office Location: Molina Center (200 Tower)
Employee Status: 1-Staff Full Time
Req ID: 21165BR
Job Description:
Job Summary
Responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse across the Molina Enterprise. Duties include generating accurate and timely analysis and reports to support the SIU initiatives to identify fraud, waste, and abuse. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.
Responsibilities may include importing, cleaning, transforming, validating or modeling data with the purpose of understanding or making conclusions from the data for decision-making purposes. Additional responsibilities may include creating presentations, graphic organizers or detailed reports of data. A data analyst will present his/her findings individually or with a group of his/her peer that cooperatively works to give supervisors or clients a synopsis of their findings.
The main responsibility of the data analyst involved understanding and interpreting data collected. The data analyst will present their conclusions in charts, graphs, or spreadsheets, so clients or other members of the Company can easily understand the information. The data analyst must import, clean and validate data, often using databases he/she designed for this purpose. The data analyst must also write reports and answer questions concerning the results.
Essential Functions
? Extract and compile various sources of information and large data sets from various systems to identify and analyze outlier coding/billing practices.
? Set up process for monitoring, tracking, and trending fraud, waste, and abuse using various systems.
? Prepare in an organized manner SIU outlier reports and analysis for use by the department when determining whether to pursue an investigation and/or to provide additional information during an investigation.
? Work with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes.
? Implement and use the fraud analytics software and systems to support the SIU?s goals in maximizing overpayment and recovery potential.
? Developing reports for tracking recoveries.
Knowledge/Skills/Abilities
? Ability to handle multiple priorities/projects in a fast-paced professional environment.
? Demonstrate performance in meeting time-sensitive deadlines with minimal supervision.
? Demonstrate adaptability and flexibility to changes; responsive to new ideas, systems, and ad hoc requests.
? Ability to abide by Molina?s policies.
? Participate in and update personal goals and objectives.
? Ability to analyze difficult, sensitive, and/or confidential situations.
? Excellent verbal and written communication skills.
? Maintain regular attendance based on agreed-upon schedule.
? 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.
? Computer literacy and use of applicable systems and software.
Job Qualifications:
Required Education:
Bachelor?s degree in IS or related qualitative field (finance, computer science, mathematics, etc.)
Required Experience:
Two (2) or more years of experience in a health care environment.
Must have working knowledge of the managed health care business, including data analysis.
Must have working knowledge of medical coding.
Possess strong math and analytical skills.
Good working knowledge of Excel and relational databases/SQL Server.
Strong background in extracting and compiling data, creating reports, and displaying information, along with experience combining clinical and financial data.
Required Licensure/Certification:
N/A
Posting Title: SIU Data Analyst
State and City: CA-Long Beach
State: California (CA)
Office Location: Molina Center (200 Tower)
Employee Status: 1-Staff Full Time
Req ID: 21165BR
Job Description:
Job Summary
Responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse across the Molina Enterprise. Duties include generating accurate and timely analysis and reports to support the SIU initiatives to identify fraud, waste, and abuse. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Affairs, in order to achieve and maintain appropriate anti-fraud oversight.
Responsibilities may include importing, cleaning, transforming, validating or modeling data with the purpose of understanding or making conclusions from the data for decision-making purposes. Additional responsibilities may include creating presentations, graphic organizers or detailed reports of data. A data analyst will present his/her findings individually or with a group of his/her peer that cooperatively works to give supervisors or clients a synopsis of their findings.
The main responsibility of the data analyst involved understanding and interpreting data collected. The data analyst will present their conclusions in charts, graphs, or spreadsheets, so clients or other members of the Company can easily understand the information. The data analyst must import, clean and validate data, often using databases he/she designed for this purpose. The data analyst must also write reports and answer questions concerning the results.
Essential Functions
? Extract and compile various sources of information and large data sets from various systems to identify and analyze outlier coding/billing practices.
? Set up process for monitoring, tracking, and trending fraud, waste, and abuse using various systems.
? Prepare in an organized manner SIU outlier reports and analysis for use by the department when determining whether to pursue an investigation and/or to provide additional information during an investigation.
? Work with internal, external and enterprise clients as needed to research, develop, and document new standard reports or processes.
? Implement and use the fraud analytics software and systems to support the SIU?s goals in maximizing overpayment and recovery potential.
? Developing reports for tracking recoveries.
Knowledge/Skills/Abilities
? Ability to handle multiple priorities/projects in a fast-paced professional environment.
? Demonstrate performance in meeting time-sensitive deadlines with minimal supervision.
? Demonstrate adaptability and flexibility to changes; responsive to new ideas, systems, and ad hoc requests.
? Ability to abide by Molina?s policies.
? Participate in and update personal goals and objectives.
? Ability to analyze difficult, sensitive, and/or confidential situations.
? Excellent verbal and written communication skills.
? Maintain regular attendance based on agreed-upon schedule.
? 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.
? Computer literacy and use of applicable systems and software.
Job Qualifications:
Required Education:
Bachelor?s degree in IS or related qualitative field (finance, computer science, mathematics, etc.)
Required Experience:
Two (2) or more years of experience in a health care environment.
Must have working knowledge of the managed health care business, including data analysis.
Must have working knowledge of medical coding.
Possess strong math and analytical skills.
Good working knowledge of Excel and relational databases/SQL Server.
Strong background in extracting and compiling data, creating reports, and displaying information, along with experience combining clinical and financial data.
Required Licensure/Certification:
N/A