Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Albuquerque (NM); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare organization is seeking a Sr. Analyst in Healthcare Analytics to evaluate healthcare intervention program performance. This role involves analyzing claims data, developing reports, and providing strategic insights to improve financial outcomes. The ideal candidate will possess strong SQL skills and experience in healthcare analytics. Join a dynamic team that values data-driven decision-making and offers competitive benefits.

Qualifications

• 5-7 years of complex database and data management responsibilities.
• 5-7 years of experience analyzing healthcare financial metrics.

Responsibilities

• Responsible for Program Valuation within Molina's Risk Adjustment Actuarial team.
• Conducts analysis across multiple states and lines of business.

Skills

Data Integrity

Financial Analysis

Data Structures

SQL

Communication

Education

Bachelor's Degree in Finance

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Tools

Power BI

Tableau

Databricks

Spark SQL

SQL Server

Job description

Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

Job Description

This Sr. Analyst, Healthcare Analytics role will be responsible for Program Valuation within 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 ROI analyses, incremental conditions captured, and other program performance reports, including forecasts and recommendations. Performs strategic analysis and planning across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Conducts 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 tools as needed.
• Reporting includes program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, forecasts, and deep dives to improve financial results.
• Ownership of root cause analysis to ensure 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 such as CMS models for Medicare Advantage, HHS model for Commercial ACA, CDPS for Medicaid, etc.
• Strong attention to detail and knowledge of data structures and programming.
• Performing financial analysis to support healthcare management and decisions.
• Understanding data storage and sharing best practices.
• Transforming data into accessible insights for strategic decisions.
• Developing reports and analyses for senior management, with effective communication of results.
• Gathering and documenting requirements to ensure accurate report creation, using peer review and end-user input.
• Practicing independent judgment, consulting experts as needed, and utilizing resources to critique results.
• Managing multiple projects and delivering results in a fast-paced, evolving 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.
• 5-7 years of experience quantifying, measuring, and analyzing healthcare financial and performance metrics.
• Healthcare experience in analyzing financial and utilization metrics.
• Advanced SQL knowledge.
• Proficiency in Excel and visualization tools like Power BI, Tableau, or similar.

Preferred Education

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

Preferred Experience

• Experience in Medical Economics and knowledge of performance indicators.
• Proactive investigation of risk adjustment initiatives, risk score lift, and program value.
• In-depth analysis of suspect areas with corrective recommendations.
• Use of healthcare analytics and predictive modeling.
• Forecasting program value and population trends to support finance, pricing, and actuarial teams.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I preferred.
• Experience with multiple data systems and models, data modeling, and BI tools.

To all current Molina employees: Apply through the intranet job listing if interested.

Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

#PJCorp

Pay Range: $77,969 - $155,508 / ANNUAL

• Compensation varies based on location, experience, education, and skills.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• IT Services and IT Consulting

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