Senior Analyst, Quality Analytics & Performance Improvement - Power BI/SQL/Hedis - Remote

Molina Healthcare; Dayton (OH); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a skilled Analyst for Quality Analytics and Performance Improvement. In this dynamic role, you will design and develop reporting solutions that enhance healthcare quality metrics and support HEDIS audits. Collaborating with various departments, you'll analyze complex data sets and assist in predictive modeling to drive performance improvements. If you're passionate about data and want to make a meaningful impact in healthcare, this opportunity is perfect for you. Join a team that values innovation and strives for excellence in health plan performance.

Qualifications

• 5+ years in data mapping, scrubbing, and cleaning.
• Experience with SQL and data design in managed care organizations.
• Familiarity with data science techniques and languages like Python and R.

Responsibilities

• Develop reporting solutions for HEDIS audits and rate tracking.
• Analyze managed care data and support quality department initiatives.
• Work cross-functionally to document requirements and educate users.

Skills

Data Mapping

SQL

Data Scrubbing

Statistical Analysis

Predictive Modeling

Data Analysis

Python

R

Education

Bachelor's Degree in Computer Science

Bachelor's Degree in Finance

Bachelor's Degree in Math

Bachelor's Degree in Economics

Tools

Microsoft T-SQL

SSIS

SSRS

Azure

AWS

Hadoop

Job description

Job Description

Job Summary

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. This role involves designing and developing reporting solutions to assist with HEDIS audits, rate tracking, and identifying targeted interventions and tracking outcomes. The analyst will also assist with research, development, and completion of special performance improvement projects.

ESSENTIAL JOB DUTIES:

• Work cross-functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports.
• Assist Quality Data Analytics Leaders in predictive intervention strategy analytics, along with tracking the progress and impact of such interventions.
• Assist in retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develop medical record review project reporting to track progress and team productivity.
• Develop and QA ad-hoc and automated analytical and reporting modules related to Quality/HEDIS for Medicaid, Marketplace, and Medicare/MMP.
• Analyze and report on managed care data such as medical claims, pharmacy, lab, and HEDIS rates.
• Support the Quality department with HEDIS measure deep dives for audits and revenue at risk reporting.
• Calculate and track HEDIS rates for intervention outcomes, overall markets, and lines of business.
• Work in an agile environment to analyze large organizational data sets, perform data mining, verification, scrubbing, and root cause analysis.
• Perform root cause analysis for business data issues as assigned.
• Analyze data trends for anomalies, outliers, and opportunities using statistical tools and techniques, including forecasting future trends.
• Participate in research and development of special projects as needed.
• Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules.
• Conduct impact analyses for logic and source code changes in analytics and reporting modules.
• Develop expertise as a HEDIS subject matter expert to improve health plan performance on underperforming measures.

Job Qualifications

Required Education: Bachelor's Degree in Computer Science, Finance, Math, Economics, or equivalent discipline.

Required Experience:

• 5+ years in data mapping, scrubbing, scrapping, and cleaning.
• 5+ years in a managed care organization role involving SQL, data design.
• Experience with Microsoft T-SQL, SSIS, and SSRS.
• Familiarity with data science techniques and languages like Python and R is a plus.
• 3+ years with cloud platforms like Azure, AWS, or Hadoop.
• 3+ years in predictive modeling in healthcare quality data.
• 3+ years in analysis related to HEDIS rate tracking, medical record review, and intervention tracking across Medicaid, Marketplace, or Medicare/MMP.
• 3+ years in analyzing complex data for financial, performance, and utilization metrics.
• 3+ years in statistical analysis and trend forecasting in healthcare data.

Physical Demands:

Work environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment with minimal exposure to unpleasant/unhealthy conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made for individuals with disabilities to perform essential functions.