Senior Analyst, Risk Adjustment - Predictive Analytics - RADV Audits/Databricks/SQL/Python - Remote

Molina Healthcare; Grand Rapids (MI); Remote; USD 77,000 - 156,000; Full time

Job summary

A healthcare organization in Grand Rapids is seeking a Senior Analyst for the RADV team. You will analyze healthcare data, collaborate with IT and clinical teams, and support CMS audit execution. Required qualifications include a Bachelor's degree and experience with Databricks and SQL analytics. This role offers a competitive salary ranging from $77,969 to $155,508 based on experience and location.

Qualifications

• 3-5 Years of experience with healthcare-related data.
• 3-5 Years of experience with advanced SQL-based analytics.
• 3-5 years of experience in working with Databricks.
• 3-5 Years of experience in health plan Risk Adjustment analytics.

Responsibilities

• Support RADV audit execution by identifying data sources.
• Analyze structured and unstructured data sets using Databricks SQL.
• Collaborate with internal stakeholders for data sourcing.
• Interpret CMS audit specifications into data logic.

Skills

Data analysis

SQL

Data validation

Problem-solving

Collaboration

Education

Bachelor's Degree in Computer Science

Bachelor's Degree in Finance

Bachelor's Degree in Math

Bachelor's Degree in Economics

Tools

Databricks

SQL

Python

Job description

Job Description

Job Summary

The Senior Analyst will serve a key role on the RADV (Risk Adjustment Data Validation) team, contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles by identifying, synthesizing, and validating source data needed to build chart retrieval chase lists for medical record collection. Success in this role requires a blend of strong technical acumen, business context, and analytical curiosity. While data is primarily accessed through Databricks, not all required elements are neatly organized or centralized. The analyst will be expected to investigate and connect disparate data sources, with the support of experienced team members and cross-functional partners. This is a collaborative role well-suited for individuals who enjoy navigating ambiguity, solving complex problems, and contributing to initiatives that directly support regulatory and clinical compliance.

Knowledge/Skills/Abilities

• Support RADV audit execution by identifying appropriate data sources, validating CMS audit samples, and generating chart retrieval chase lists in coordination with internal teams.

• Analyze structured and unstructured data sets using Databricks SQL and other tools to locate and confirm data elements required for audit response.

• Collaborate with internal stakeholders—including IT, Risk Adjustment operations, clinical teams, and retrieval vendors—to ensure accurate data sourcing and alignment with audit requirements.

• Interpret CMS audit specifications and translate them into data logic and operational requirements.

• Document methodology, assumptions, and data sourcing logic to maintain audit traceability and facilitate knowledge sharing.

• Assist in preparing for internal simulations and proactive readiness assessments related to RADV audits.

• Investigate data inconsistencies and assist in performing root cause analysis, offering insight into potential data gaps or operational improvements.

• Work iteratively and adaptively when data is incomplete or spread across multiple systems, using sound judgment to build defensible audit datasets.

• Present findings and progress updates to project leads and stakeholders, contributing to a collaborative, informed audit response process.

Job Qualifications

Required Education

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline

Required Experience

• 3-5 Years of experience with healthcare-related data (claims/encounters, provider, CMS/EDGE response files, etc.

• 3-5 Years of experience with advanced SQL-based analytics (procedures, window functions, dyanamic SQL, ETC.)

• 3-5 years of experience in working with Databricks for analytics and workflows.

• 3-5 Years of experience in health plan Risk Adjustment analytics.

• Core database fundamentals (Primary/Foreign Keys, Relational Databases, Normalization, Transactions, etc.)

• 1-3 years of programming experience in python to support automated data validation / processing at scale (functions and objects)

PHYSICAL DEMANDS

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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 - $155,508 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.