Health Plan Risk & Quality Reporting Specialist

Molina Healthcare, Inc.; Clayton (NM); À distance; USD 70 000 - 110 000; Plein temps

Avantages offerts par ce poste

Competitive benefits

Résumé du poste

Molina Healthcare is seeking a Health Plan Data Analyst to support risk and quality reporting for Medicaid, Medicare, Marketplace, and MMP. The role involves designing custom reports, educating users, and guiding intervention strategies to close gaps in HEDIS performance.

The ideal candidate will have 2+ years of data cleansing experience related to HEDIS or risk adjustment, strong SQL and Power BI skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.

Qualifications

• 2+ years of experience mapping, scrubbing, and cleaning data related to HEDIS or risk adjustment.
• Analytical mindset with strong attention to detail.
• Experience with complex data to quantify, measure, and analyze performance metrics.
• Experience with 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 and ability to translate data to strategic goals.
• Excellent verbal and written communication skills.

Responsabilités

• Captures and documents health plan quality reporting requirements; builds custom reports and educates users.
• Builds intervention strategy reporting for risk and quality measures gap closure.
• Creates ad hoc quality reports to track HEDIS performance and data monitoring.
• Develops QA reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Develops custom health plan reports for managed care data, including claims, pharmacy, lab and HEDIS rates.
• Collaborates with national risk and quality teams on testing pre-production reporting.
• Calculates and tracks gap closure and intervention outcomes for the health plan.
• Performs data analysis, data mining, and root-cause analysis in a data warehouse environment.
• Represents as a HEDIS SME to support performance improvement on underperforming measures.

Connaissances

Data mapping and cleaning

SQL and Databricks

Power BI

Data analysis

Multi-tasking

HEDIS knowledge

Communication skills

Outils

T-SQL

Databricks SQL

Power BI

Azure/AWS/Hadoop

Description du poste

Molina Healthcare is seeking a Health Plan Data Analyst to support risk and quality reporting for Medicaid, Medicare, Marketplace, and MMP. The role involves designing custom reports, educating users, and guiding intervention strategies to close gaps in HEDIS performance.

The ideal candidate will have 2+ years of data cleansing experience related to HEDIS or risk adjustment, strong SQL and Power BI skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.