Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Molina Healthcare; Akron (OH); Remote; USD 70,000 - 110,000; Full time

Job summary

An established industry player is seeking a Sr. Analyst in Healthcare Analytics to join their dynamic team. This role focuses on analyzing complex healthcare data to evaluate program performance and make strategic recommendations. You will leverage advanced SQL and analytical tools to drive insights and improve financial outcomes. If you have a passion for healthcare analytics and a strong background in data management, this opportunity offers a chance to make a significant impact in a fast-paced environment. Join a company that values innovation and excellence in healthcare management.

Benefits

Competitive Benefits Package

Equal Opportunity Employer

Flexible Work Environment

Qualifications

• 5-7 years of complex database and data management responsibilities.
• Advanced knowledge of SQL and proficiency in Excel and visualization tools.

Responsibilities

• Analyze complex healthcare claims data and evaluate program performance.
• Develop and present reports on Risk Adjustment intervention ROI and metrics.

Skills

Data Analysis

SQL

Healthcare Analytics

Financial Analysis

Attention to Detail

Education

Bachelor's Degree in Finance

Bachelor's Degree in Computer Science

Bachelor's Degree in Economics

Tools

Power BI

Tableau

Databricks

Spark SQL

SQL Server

Job description

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 complex 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 health care data using Databricks and 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, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
• Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
• Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
• Complete analysis and forecasting of risk adjustment intervention program values
• Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
• Must have a strong attention to detail and knowledge of data structure and programming
• Performing financial analysis to assist in delivering optimal health care management and decision making
• Understanding and applying data storage and data sharing best practices
• Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
• Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
• Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
• Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
• Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Finance, Economics, Computer Science

Required Experience

• 5-7 years increasingly complex database and data management responsibilities
• 5-7 years of increasingly complex experience in quantifying, measuring, and analyzing financial / performance management metrics
• Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
• Advanced knowledge of SQL
• Proficient in Excel and visualization tools such as Power BI, Tableau, or similar

Preferred Education

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

Preferred Experience

Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators :

• Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators :
• Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
• Initiate in-depth analysis of the suspect / problem areas and suggest a corrective action plan
• Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
• Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
• Multiple data systems and models
• Data modelling and BI tools

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.

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