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Data Analyst jobs at HCA Healthcare

- 42 jobs
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    New York, NY jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $117.7k-275.5k yearly 60d+ ago
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    Cleveland, OH jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $87k-114k yearly est. 60d+ ago
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    Akron, OH jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $87k-114k yearly est. 60d+ ago
  • Technical Data Migration Consultant

    Galen 3.3company rating

    Chicago, IL jobs

    Job Description70000-95000 RLDatix is on a mission to transform care delivery worldwide, ensuring every patient receives the safest, highest-quality care. Through our innovative Healthcare Operations Platform, we're connecting data to unlock trusted insights that enable improved decision-making and help deliver safer healthcare for all. At RLDatix we're making healthcare safer, together. Our shared passion for meaningful work drives us, while a supportive, respectful culture makes it all possible. As a team, we collaborate globally to reach our ultimate goal-helping people. We're searching for a Technical Data Migration Consultant to join our team to help shape the future of healthcare innovation. The Role: Technical Data Migration Consultant What You Will Do: The Technical Data Migration Consultant will work for our subsidiary company, Galen Healthcare Solutions LLC. This role supports our clients by extracting data from previous EHRs and ancillary healthcare IT systems, transforming the data into new formats, and then importing the data into their new go forward EHRs. In addition to performing this technical work, the Technical Data Migration consultant will use their interpersonal, communication, and organizational skills to work with various internal and external stakeholders and to drive each project toward completion. Key Responsibilities: Develop, test, and execute data conversions including extracting healthcare data from various EHR systems, performing transformations upon the data, and importing it into target EHR (Epic, MEDITECH, Cerner, Allscripts) Analyze healthcare data in HL7, CDA, CSV, and SQL formats for extraction, transformation, and import. Convert data from multiple data sources, including creation of complex scripts with limited assistance. Facilitate meetings with multiple internal and external stakeholders to gather requirements, identify data conversion needs, provide ongoing updates, and ensure high customer satisfaction. Provide quality assurance on data conversion work: verify data integrity and identify data cleanliness issues and reconcile converted data to ensure accuracy. Develop and update technical and business process documentation for data conversions (internal and customer-facing) Participate in informal internal training as part of ongoing team improvement. Work and manage support tickets independently. Establish strong relationships with co-workers and clients and provide exemplary customer service by understanding and resolving issues quickly. Participate in process improvement efforts. Other duties as assigned. Experience/Knowledge/Competencies You Will Need: 3+ years of experience working with healthcare data. 3+ years of experience working with EHRs/EMRs High technical proficiency with Microsoft SQL Server, including the ability to create and edit complex queries and T-SQL scripts including dynamic SQL, required; experience with SSIS. Experience working with the HL7 standard. Familiarity with a variety of database types and interfaces (Microsoft Access, Oracle, various text formats, ODBC, OLE DB) Current Epic Bridges certification is desired or willingness to obtain. Direct experience in bridging the gap between end user requirements and technology solutions. Bachelor's degree in computer science, engineering, information systems or a related field requirement. Equivalent knowledge and skills obtained through a combination of education, training and experience may meet this requirement. Work Location and Schedule Requirements: · This position is 100% remote. Work from home requirements are: Ability to work independently and efficiently from a home office environment. High Speed Internet Service It is a requirement that employees work in a distraction-free workplace. Occasional nights and weekends as dictated by client By enabling flexibility in how we work and prioritizing employee wellness, we empower our team to do and be their best. Key benefits include private health and group accident insurance, an Employee Assistance Program (EAP) for confidential support, and Loyalty Awards for long-service employees. RLDatix is an equal opportunity employer, and our employment decisions are made without regard to race, color, religion, age, gender, national origin, disability, handicap, marital status or any other status or condition protected by law. As part of RLDatix's commitment to the inclusion of all qualified individuals, we ensure that persons with disabilities are provided reasonable accommodation in the job application and interview process. If reasonable accommodation is needed to participate in either step, please don't hesitate to send a note to accessibility@rldatix.com.
    $76k-103k yearly est. 30d ago
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    Cincinnati, OH jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $86k-112k yearly est. 60d+ ago
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    Dayton, OH jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $86k-112k yearly est. 60d+ ago
  • Principal Data Scientist - Generative AI, Machine Learning, Python, R - Remote

    Molina Healthcare 4.4company rating

    Ohio jobs

    Responsible for overseeing data science projects, managing and mentoring a team, and aligning data initiatives with business goals. Lead the development and implementation of data models, collaborate with cross-functional teams, and stay updated on industry trends. Ensure ethical data use and communicate complex technical concepts to non-technical stakeholders. Lead initiatives on model governance and model ops to align with regulatory and security requirements. This role requires technical expertise, strategic thinking, and leadership to drive data-driven decision-making within the organization and be the pioneer on generative AI healthcare solutions, aimed at revolutionizing healthcare operations as well as enhancing member experience. **Job Duties** - **Research and Development:** Stay current with the latest advancements in AI and machine learning and apply these insights to improve existing models and develop new methodologies. - **AI Model Deployment, Monitoring & Model Governance:** Deploy AI models into production environments, monitor their performance, and adjust as necessary to maintain accuracy and effectiveness and meet all governance and regulatory requirements. - **Innovation Projects:** Lead pilot projects to test and implement new AI technologies within the organization - **Data Analysis and Interpretation:** Extract meaningful insights from complex datasets, identify patterns, and interpret data to inform strategic decision-making. - **Machine Learning Model Development** : Design, develop, and train machine learning models using a variety of algorithms and techniques, including supervised and unsupervised learning, deep learning, and reinforcement learning. - **Agentic Workflows Implementation:** Develop and implement agentic workflows that utilize AI agents for autonomous task execution, enhancing operational efficiency and decision-making capabilities. - **RAG Pattern Utilization:** Employ retrieval-augmented generation patterns to improve the performance of language models, ensuring they can access and utilize external knowledge effectively to enhance their outputs. - **Model Fine-Tuning** : Fine-tune pre-trained models to adapt them to specific tasks or datasets, ensuring optimal performance and relevance in various applications. - **Data Cleaning and Preprocessing:** Prepare data for analysis by performing data cleaning, handling missing values, and removing outliers to ensure high-quality inputs for modeling. - **Collaboration:** Work closely with cross-functional teams, including software engineers, product managers, and business analysts, to integrate AI solutions into existing systems and processes. - **Documentation and Reporting:** Create comprehensive documentation of models, methodologies, and results; communicate findings clearly to non-technical stakeholders. - Mentors, coaches, and provides guidance to newer data scientists. - Partner closely with business and other technology teams to build ML models which helps in improving Star ratings, reduce care gap and other business objectives. - Present complex analytical information to all level of audiences in a clear and concise manner Collaborate with analytics team, assigning and managing delivery of analytical projects as appropriate - Perform other duties as business requirements change, looking out for data solutions and technology enabled solution opportunities and make referrals to the appropriate team members in building out payment integrity solutions. - Use a broad range of tools and techniques to extract insights from current industry or sector trends **Job Qualifications** **REQUIRED EDUCATION:** Master's Degree in Computer Science, Data Science, Statistics, or a related field **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 10+ years' work experience as a data scientist preferably in healthcare environment but candidates with suitable experience in other industries will be considered - Knowledge of big data technologies (e.g., Hadoop, Spark) - Familiar with relational database concepts, and SDLC concepts - Demonstrate critical thinking and the ability to bring order to unstructured problems - **Technical Proficiency:** Strong programming skills in languages such as Python and R, and experience with machine learning frameworks like TensorFlow, Keras, or PyTorch. - **Statistical Analysis:** Excellent understanding of statistical methods and machine learning algorithms, including k-NN, Naive Bayes, SVM, and neural networks. - **Experience with Agentic Workflows:** Familiarity with designing and implementing agentic workflows that leverage AI agents for autonomous operations. - **RAG Techniques:** Knowledge of retrieval-augmented generation techniques and their application in enhancing AI model outputs. - **Model Fine-Tuning Expertise:** Proven experience in fine-tuning models for specific tasks, ensuring they meet the required performance metrics. - **Data Visualization:** Proficiency in data visualization tools (e.g., Tableau, Power BI) to present complex data insights effectively. - **Database Management:** Experience with SQL and NoSQL databases, data warehousing, and ETL processes. - **Problem-Solving Skills:** Strong analytical and problem-solving abilities, with a focus on developing innovative solutions to complex challenges. **PREFERRED EDUCATION:** PHD or additional experience **PREFERRED EXPERIENCE:** - Experience with cloud platforms (e.g., Databricks, Snowflake, Azure AI Studio etc.) for working with AI workflows and deploying models. - Familiarity with natural language processing (NLP) and computer vision techniques. \#PJCorp2 \#LI-AC1 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: $117,731 - $275,491 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $87k-113k yearly est. 60d+ ago
  • Enterprise Data Scientist

    Community Health Systems 4.5company rating

    Remote

    This role is responsible for leveraging your expertise in data analytics, advanced statistical methods, and programming to derive insights from clinical data. As a member of the Enterprise Data Science team, this role will be responsible for analyzing complex clinical datasets, developing data visualizations and dashboards, assisting with data model and/or feature development, and translating insights into actionable recommendations for improving patient care and operational outcomes. Responsibilities: Collaborate with cross-functional teams including clinical leaders, data scientists, and software engineers to identify data-driven opportunities for enhancing clinical processes and patient care. Utilize cloud-based technologies, such as Google Cloud Platform (GCP), for scalable data processing and analysis. Develop easily consumable dashboards from complex clinical and operational data to provide visualizations derived from best practices and data consumption theory that drive healthcare and business performance. Implement best practices for data management, including data quality assessment, data validation, and data governance. Utilize Python programming and associated libraries such as PyTorch, Keras, Pandas and NumPY to create, train, test and implement meaningful data science models. Lead the analysis of operational data to identify patterns, trends, and correlations relevant to healthcare outcomes. Collaborate with healthcare professionals and domain experts to understand operational needs and design data-driven solutions. Design and conduct experiments, interpret results, and communicate findings to both technical and non-technical stakeholders Requirements: Master's degree in Data Science, Data Analytics, Computer Science, or a related field. Proven experience in analyzing complex healthcare data and building customer facing dashboards and data visualizations. Proficiency in Python programming and associated libraries. Experience with cloud-based platforms such as Google Cloud Platform (GCP) for data storage, processing, and deployment. Strong problem-solving skills and ability to work independently and collaboratively in a fast-paced environment. Excellent communication and presentation skills with the ability to translate technical concepts to non-technical audiences.
    $99k-128k yearly est. Auto-Apply 3d ago
  • Oracle Enterprise Data Scientist

    Community Health Systems 4.5company rating

    Remote

    We are seeking a highly specialized and experienced Enterprise Data Scientist to drive data quality, standardization, and insight generation across our core Oracle operational suite. This role serves as the authoritative expert on translating complex, high-volume data from Oracle Supply Chain Management (SCM), Oracle Procurement, Oracle Revenue Cycle Management (RCM), and Oracle Inventory into actionable business intelligence. The successful candidate will be focused on ensuring absolute data integrity-a critical function in a regulated healthcare environment-and transforming raw transactional data into high-value operational reports, interactive dashboards, and predictive models that optimize cost-per-case, enhance inventory accuracy, and accelerate the revenue cycle. Essential Functions 1. Data Validation, Integrity, and Compliance (Critical Focus) Healthcare Data Quality Assurance: Design and implement automated data validation frameworks specific to healthcare operations, ensuring transactional data (e.g., supply usage, procedure charging, contract pricing) is accurate. Compliance Verification: Develop reports and monitoring tools to detect anomalies and discrepancies that could impact regulatory reporting, financial audits (e.g., SOX implications), or compliance with GPO contracts and payer rules. Revenue Leakage Identification: Specifically focus on validating the link between inventory consumption (SCM) and patient billing (RCM) data to prevent charge capture errors, ensuring accurate patient bills and maximizing appropriate reimbursement. Root Cause Analysis: Investigate and diagnose data errors originating in Oracle system configurations (EBS or Fusion), ensuring the integrity of critical data points like item master definitions, vendor codes, and pricing tiers. 2. Standardized Operational Analytics and Reporting KPI Development (Healthcare Specific): Define, standardize, and institutionalize critical operational metrics across the organization, such as: Inventory Accuracy Rate for Critical Supplies Procurement Compliance Rate (Off-Contract Spend) Days of Supply (DOS) for high-value pharmaceuticals and implants Cost-Per-Case Variance analysis (linking supply cost to procedure type) Claims Denial Rate Analysis linked to operational inputs High-Value Reporting: Develop and maintain standardized operational reports and interactive dashboards (e.g., Tableau, Power BI) focused on optimizing the efficiency and spend within the OR, Clinics, and centralized purchasing departments. Executive Insights: Create visually compelling and accurate reports for executive leadership on the overall health and financial performance driven by Oracle system outputs. 3. Advanced Modeling and Process Optimization Predictive Inventory Modeling: Develop sophisticated models to forecast demand volatility (e.g., flu season spikes, pandemic-related surges) for critical supplies and pharmaceuticals, minimizing shortages and excess waste. Revenue Cycle Modeling: Build predictive models to forecast cash flow, anticipate denials based on procurement/charging patterns, and prioritize RCM work queues based on expected return. Efficiency Optimization: Utilize machine learning techniques to optimize logistics (e.g., warehouse routing, supply replenishment schedules) and procurement processes (e.g., automated purchase order generation based on consumption velocity). 4. Collaboration and System Expertise Serve as the technical data expert for functional Oracle teams (Finance, Clinical Operations, Materials Management), bridging the gap between business needs and data structure. Document data lineage, metric definitions, and model methodologies to ensure transparency and trust in derived insights across the enterprise. Required Qualifications: Education: Master's degree in Data Science, Health Informatics, Statistics, Industrial Engineering, or a related quantitative field. Experience: 2+ years of experience in a specialized data science, BI, or analytics role, working within a large healthcare system, hospital, or payer environment. Deep Oracle Domain Expertise (Mandatory): Proven practical experience analyzing, querying, and understanding the complex data models within at least two of the following Oracle applications (EBS or Fusion): Oracle Supply Chain Management (SCM) & Inventory: Specific understanding of item masters, warehouse transactions, and consumption data. Oracle Procurement: Expertise in purchase order data, contract management, and vendor performance metrics. Oracle Revenue Cycle Management (RCM): Understanding of charge capture, billing, and the data linkage to operational inputs. Technical Proficiency: Expert-level SQL skills for complex database querying, including experience navigating Oracle tables/views. Proficiency in Python or R, with experience in statistical modeling, time series analysis, and machine learning libraries. Experience developing advanced visualizations using industry-leading tools (Tableau, Power BI). Demonstrable experience working with large-scale Enterprise Data Warehouses (EDW) in a regulated environment. Preferred Skills and Attributes Familiarity with clinical coding standards (CPT, ICD-10) as they relate to procedure costing and RCM data. Understanding of HIPAA, HITECH, and general healthcare data governance standards. Experience with advanced analytics applied to surgical services or procedural areas. Excellent collaboration and communication skills, with the ability to present complex analytical findings to clinical and executive audiences. Certification in Oracle applications or cloud platforms is a plus.
    $99k-128k yearly est. Auto-Apply 45d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Columbus, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Cleveland, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Akron, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Cincinnati, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare Inc. 4.4company rating

    Cincinnati, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. Knowledge/Skills/Abilities * Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. * Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. * Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. * Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. * Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. * Coordinate, facilitate and document audit walkthroughs. * Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. * Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. * Ability to write SQL queries * Experience with QNXT configuration * Experience with troubleshooting and analyzing issues. * Experience working in a Medicare environment is highly preferred. * Claims adjudication experience is highly preferred. Job Qualifications Required Education Associate's Degree or two years of equivalent experience Required Experience * Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: * Analytical experience within managed care operations. * Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education Bachelor's Degree Preferred Experience * Six years proven analytical experience within an operations or process-focused environment. * Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $78k-116.8k yearly 18d ago
  • QNXT Configuration Analyst

    Molina Healthcare Inc. 4.4company rating

    Akron, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. Knowledge/Skills/Abilities * Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. * Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. * Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. * Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. * Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. * Coordinate, facilitate and document audit walkthroughs. * Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. * Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. * Ability to write SQL queries * Experience with QNXT configuration * Experience with troubleshooting and analyzing issues. * Experience working in a Medicare environment is highly preferred. * Claims adjudication experience is highly preferred. Job Qualifications Required Education Associate's Degree or two years of equivalent experience Required Experience * Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: * Analytical experience within managed care operations. * Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education Bachelor's Degree Preferred Experience * Six years proven analytical experience within an operations or process-focused environment. * Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $78k-116.8k yearly 18d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Dayton, OH jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare 4.4company rating

    Ohio jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. **Knowledge/Skills/Abilities** + Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. + Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. + Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. + Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. + Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. + Coordinate, facilitate and document audit walkthroughs. + Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. + Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. + Ability to write SQL queries + Experience with QNXT configuration + Experience with troubleshooting and analyzing issues. + Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** Associate's Degree or two years of equivalent experience **Required Experience** - Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: - Analytical experience within managed care operations. - Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's Degree **Preferred Experience** - Six years proven analytical experience within an operations or process-focused environment. - Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $78k-116.8k yearly 16d ago
  • QNXT Configuration Analyst

    Molina Healthcare Inc. 4.4company rating

    Ohio jobs

    Responsible for providing business process redesign, communication and change management for operations. Backend operationalization of policies, standardization of system set-up and a resource for all departments and health plans company-wide. Knowledge/Skills/Abilities * Conduct interviews with staff and management to assess internal business processes within a department or function to ensure compliance with existing organizational Policies and Procedures, Standard Operating Procedures and other internal guidelines. * Review, research, analyze and evaluate information to assess compliancy between a process or function and the corresponding written documentation. Use analytical skills to identify variances. Use problem solving skills and business knowledge to make recommendations for process remediation or improvement. * Summarize and document assessment outcomes and recommendations. Ensure that they are appropriately communicated (written and verbal) to process owners and management. * Collaborate with process owners to maintain and/or create business process documentation and workflows related to Core Operations functions. * Serve as liaison between Core Operations and internal and external auditors for all formal Core Operations audits that are not compliance related. * Coordinate, facilitate and document audit walkthroughs. * Research, collect or generate requested documentation. Provide timely and accurate responses, both written and verbal. * Research and respond to clarifying questions submitted by internal and external auditors. Work in partnership with other functional areas as needed.. * Ability to write SQL queries * Experience with QNXT configuration * Experience with troubleshooting and analyzing issues. * Experience working in a Medicare environment is highly preferred. * Claims adjudication experience is highly preferred. Job Qualifications Required Education Associate's Degree or two years of equivalent experience Required Experience * Four years proven analytical experience within an operations or process-focused environment. Additional required experience for Corporate Operations: * Analytical experience within managed care operations. * Knowledge of managed care enrollment processes, encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. Preferred Education Bachelor's Degree Preferred Experience * Six years proven analytical experience within an operations or process-focused environment. * Previous audit and/or oversight experience. 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 - $116,835 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $78k-116.8k yearly 18d ago
  • Inpatient Coding Denials Analyst - Full Time - Days

    Texas Health Resources 4.4company rating

    Arlington, TX jobs

    Inpatient Coding Denials Analyst _Are you looking for a rewarding career with an award-winning company? We're looking for a qualified_ Inpatient Coding Analyst _like you to join our Texas Health family._ Work hours: Monday through Friday (full time hours) HIMS Coding Department Highlights: + 100% remote work + Flexible hours/scheduling + Terrific work/life balance Here's What you Need Education Associate's Degree Health Information Services or related field REQUIRED or H.S. Diploma or Equivalent 2 Years Coding experience in lieu of degree REQUIRED Experience 3 Years Coding in an acute care setting REQUIRED 2 Years Performing billing and coding denials resolution preferred Licenses and Certifications CCS - Certified Coding Specialist 12 Months REQUIRED or CCA - Certified Coding Associate 12 Months REQUIRED or RHIA - Registered Health Information Administrator 12 Months REQUIRED or RHIT - Registered Health Information Technician 12 Months REQUIRED or CPC - Certified Professional Coder 12 Months REQUIRED Skills Demonstrates the ability to locate, research, comprehend and appropriately apply 3rd party payer rules and regulations. Able to analyze and resolve complex coding related claim denials in a manner that ensures accurate and optimal reimbursement. Proficient in Microsoft Office and billing software applications. Thorough understanding of ICD9-CM, DRG methodologies, CPT-4, Outpatient Code Editor and National Correct Coding Initiative policies. Demonstrates clear and concise oral and written communication skills. Demonstrates strong decision making and problem solving skills. Personal initiative to keep abreast of new developments in coding updates/technology/research/regulatory data. Detail oriented and ability to meet deadlines. Ability to adjust successfully to changing priorities and work load volume. Successful completion of ICD 10 training courses. What you will do * Reviews, researches, resolves and trends billing and coding edits * Trends documentation, reimbursement, and coding * Assists the management team with Fiscal Management of coding resources and processes * Professional Accountability Additional perks of being a Texas Health Coder * Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits. * A supportive, team environment with outstanding opportunities for growth. * Explore our Texas Health careers site (https://jobs.texashealth.org/) for info like Benefits (https://jobs.texashealth.org/benefits) , Job Listings by Category (https://jobs.texashealth.org/professions) , recent Awards (https://jobs.texashealth.org/awards) we've won and more. _Do you still have questions or concerns?_ Feel free to email your questions to recruitment@texashealth.org . \#LI-JT1 Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities. We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
    $59k-82k yearly est. 27d ago
  • Inpatient Coding Denials Analyst - Full Time - Days

    Texas Health Resources 4.4company rating

    Arlington, TX jobs

    Inpatient Coding Denials Analyst - Full Time - Days - (25011411) Description Inpatient Coding Denials AnalystAre you looking for a rewarding career with an award-winning company? We're looking for a qualified Inpatient Coding Analyst like you to join our Texas Health family. Work location: RemoteWork hours: Monday through Friday (full time hours) HIMS Coding Department Highlights:100% remote work Flexible hours/scheduling Terrific work/life balance Qualifications Here's What you NeedEducationAssociate's Degree Health Information Services or related field REQUIRED orH. S. Diploma or Equivalent 2 Years Coding experience in lieu of degree REQUIREDExperience3 Years Coding in an acute care setting REQUIRED2 Years Performing billing and coding denials resolution preferred Licenses and CertificationsCCS - Certified Coding Specialist 12 Months REQUIRED or CCA - Certified Coding Associate 12 Months REQUIRED or RHIA - Registered Health Information Administrator 12 Months REQUIRED or RHIT - Registered Health Information Technician 12 Months REQUIRED or CPC - Certified Professional Coder 12 Months REQUIREDSkillsDemonstrates the ability to locate, research, comprehend and appropriately apply 3rd party payer rules and regulations. Able to analyze and resolve complex coding related claim denials in a manner that ensures accurate and optimal reimbursement. Proficient in Microsoft Office and billing software applications. Thorough understanding of ICD9-CM, DRG methodologies, CPT-4, Outpatient Code Editor and National Correct Coding Initiative policies. Demonstrates clear and concise oral and written communication skills. Demonstrates strong decision making and problem solving skills. Personal initiative to keep abreast of new developments in coding updates/technology/research/regulatory data. Detail oriented and ability to meet deadlines. Ability to adjust successfully to changing priorities and work load volume. Successful completion of ICD 10 training courses. What you will do· Reviews, researches, resolves and trends billing and coding edits· Trends documentation, reimbursement, and coding· Assists the management team with Fiscal Management of coding resources and processes· Professional Accountability Additional perks of being a Texas Health Coder· Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits. · A supportive, team environment with outstanding opportunities for growth. · Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we've won and more. Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth. org. #LI-JT1 Primary Location: ArlingtonJob: Health Information ManagementOrganization: Texas Health Resources 612 E. Lamar TX 76011Travel: NoJob Posting: Nov 17, 2025, 1:57:01 PMShift: Day JobEmployee Status: RegularJob Type: StandardSchedule: Full-time
    $59k-82k yearly est. Auto-Apply 12h ago

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