Health Plan Risk & Quality Insights Analyst

Molina Healthcare, Inc.; Santa Fe (NM); Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare, Inc. is seeking a data analyst to support health plan risk and quality reporting activities, designing custom reports and educating users on report usage for HEDIS across Medicaid, Medicare, Marketplace and MMP.

You will conduct data analyses, support quality-related projects, and work with the Datawarehouse platform to ensure accurate, actionable reporting for health plans.

Qualifications

• At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment.
• Analytical mindset with excellent attention to detail.
• Experience with complex data to quantify, measure, and analyze financial/performance metrics.
• Experience with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, AWS, or Hadoop.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong business acumen with data insights to strategic goals.

Responsibilities

• Captures and documents health plan quality reporting requirements, builds custom reports, and educates health plan users on how to use reports.
• Builds intervention strategy reporting for risk and quality interventions and measures gap closure.
• Builds ad hoc quality reports to track HEDIS performance and supplemental data monitoring.
• Develops QA custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Develops custom health plan reports related to managed care data including medical claims, pharmacy, lab and HEDIS rates.
• Collaborates with the national risk and quality team on testing of pre-production reporting for assigned health plan.
• Calculates and tracks gap closure and intervention outcome reporting for the assigned health plan.
• Works in an agile environment to derive meaningful information from large data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Represents as a HEDIS subject matter expert, and supports health plan improve performance on underperforming quality measures.

Job description

Molina Healthcare, Inc. is seeking a data analyst to support health plan risk and quality reporting activities, designing custom reports and educating users on report usage for HEDIS across Medicaid, Medicare, Marketplace and MMP.

You will conduct data analyses, support quality-related projects, and work with the Datawarehouse platform to ensure accurate, actionable reporting for health plans.