Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Akron (OH); Remote; USD 77,000 - 125,000; Full time

Job summary

A leading healthcare company is seeking a Sr Analyst for their Healthcare Analytics team. This role involves analyzing healthcare data to evaluate program performance, developing reports, and providing strategic insights. Candidates should possess strong analytical skills, a relevant degree, and experience in healthcare metrics.

Qualifications

• 5-7 years of complex database and data management responsibilities.
• Healthcare experience in metrics analysis.
• Advanced SQL knowledge required.

Responsibilities

• Conduct research and analysis on healthcare claims data.
• Develop and present program performance reports.
• Perform financial analysis to support healthcare management.

Skills

Data integrity

Analytical skills

Attention to detail

Healthcare analytics

Predictive modeling

Education

Bachelor's Degree in Finance

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Tools

SQL

Excel

Power BI

Tableau

Job description

Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

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Job Description

Job Summary

This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis, and modeling of healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).

Knowledge/Skills/Abilities

• Compiling and organizing healthcare data using Databricks, Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic/programming tools as needed.
• Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, forecasts, and deep dives to drive financial improvement.
• Ownership of root cause analysis to maintain high data integrity and minimize discrepancies.
• Creating databases and dashboards for monitoring, tracking, and trending, with automation as appropriate.
• Analysis and forecasting of risk adjustment intervention program values.
• Proficiency in running risk models for Medicare Advantage, Commercial ACA, Medicaid, and other applicable models.
• Attention to detail and strong knowledge of data structures and programming.
• Performing financial analysis to support healthcare management and decision-making.
• Applying data storage and sharing best practices.
• Converting data into understandable insights to support strategic decisions.
• Developing reports and analyses for senior management, communicating results effectively.
• Gathering and documenting report requirements, peer review, and end-user consultation.
• Practicing sound judgment, consulting with experts, and utilizing resources effectively.
• Managing multiple projects and delivering results in a fast-paced environment.

Job Qualifications

Required Education

Bachelor's Degree in Finance, Economics, or Computer Science.

Required Experience

• 5-7 years of complex database and data management responsibilities.
• Experience in quantifying, measuring, and analyzing healthcare financial and performance metrics.
• Healthcare experience in metrics analysis.
• Advanced SQL knowledge.
• Proficiency in Excel and visualization tools like Power BI or Tableau.

Preferred Education

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

Preferred Experience

• Experience in Medical Economics and knowledge of performance indicators.
• Ability to investigate complex risk adjustment areas and recommend corrective actions.
• Skills in healthcare analytics, predictive modeling, and population trend analysis.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I.
• Experience with multiple data systems, models, and BI tools.

Current Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Additional Details

• Pay Range: $77,969 - $125,000 annually.
• Seniority level: Mid-Senior level.
• Employment type: Full-time.
• Job function: Healthcare Provider.
• Industries: IT Services and Consulting.

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