Top 2 Management analysts Jobs in Tupelo, Ms

Lead Analyst, Payment Integrity - Health Plan
Molina Healthcare —Tupelo, MS
- $59,811.00 - $129,589.63 a year
- Full-time
- Mid-level
- SQL
- Organizational skills
- Health insurance

Check out these similar jobs

Based on your search for management analysts jobs.

Lead Analyst, Payment Integrity - Health Plan
Molina Healthcare —Tupelo, MS
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…
$59,811.00 - $129,589.63 a year
Revenue Cycle Claims Specialist
Druid City Vital Care —Tupelo, MS
Preferred skills such as certification and advanced software proficiency enhance the specialist’s ability to navigate complex billing scenarios and optimize…

Show more similar jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Management Analyst II (Vacancy)
City of Columbus —Columbus, OH
Develops and recommends strategies for the implementation of new programs, projects, or policies pertinent to the mission of the department or division;…
$37.02 - $55.52 an hour
7d
Investment Analyst, Enterprise Portfolio Management
Nationwide —Columbus, OH
Education: Bachelor’s degree in finance, economics, or a related field. Actively engage and debate how such changes create risks that could impact future…
5d

Show more jobs in cities nearby

I want to receive the latest job alert for management analysts in tupelo, ms

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

management analysts jobs near tupelo, ms

Lead Analyst jobs in Richmond, VA

Product Analyst jobs in Washington, DC

Lead Analyst jobs in Cleveland, OH

Lead Analyst jobs in Beaverton, OR

Data Analyst jobs in Stockton, CA

Health Policy Analyst jobs in Texas

Information Systems Analyst jobs in Los Angeles, CA

Lead Analyst jobs in Barberton, OH

Lead Analyst, Payment Integrity - Health Plan

Molina Healthcare -
Tupelo, MS

Apply Now

Job Details

Full-time
$59,811.00 - $129,589.63 a year

Benefits

Health insurance

Qualifications

Medicare coding guidelines
Managed care organization experience
Spreadsheets
Health insurance knowledge
Project management experience in healthcare
Centers for Medicare & Medicaid Services (CMS) billing regulations
Managing projects
Productivity software
Cross-functional collaboration
Financial data analysis tools
Cross-functional communication
Data analysis software

Full Job Description

JOB DESCRIPTION Job Summary

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.

Essential Job Duties

Business Leadership & Operational Ownership
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, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
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.

Strategic Business Analysis

Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.

Applied Analytical Support
Uses data analysis tools/systems to support business analysis.
Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct summaries and visualizations that enable faster leadership decision-making.

Required 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.

Preferred Qualifications

Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.

Advanced Excel (formulas, Pivot Tables)

SQL and QNXT

Claims experience

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $59,811 - $129,589.63 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

management analysts jobs in tupelo, ms

Lead Analyst, Payment Integrity - Health Plan

Check out these similar jobs

Explore jobs in cities nearby

I want to receive the latest job alert for management analysts in tupelo, ms

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected