Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

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

Job summary

A leading company in IT Services seeks a Senior Analyst for Healthcare Analytics to evaluate program performance through data analysis and reporting. Candidates should have a Bachelor's degree and 5-7 years of relevant experience in healthcare analytics, with strong SQL and data management skills. This full-time role offers a competitive salary and benefits, emphasizing strategic insights to drive healthcare decisions.

Qualifications

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

Responsibilities

• Research, analyze, and model healthcare claims and pharmacy data.
• Develop and present Risk Adjustment intervention ROI and performance reports.
• Perform financial analysis to support healthcare management decisions.

Skills

Data analysis

SQL

Excel

Healthcare metrics

Data integrity

Forecasting

Reporting

Education

Bachelor's Degree in Finance, Economics, Computer Science

Tools

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 with root cause analysis to maintain high data integrity and minimize discrepancies.
• Create databases and dashboards for monitoring, tracking, and trending; apply automation as appropriate.
• Complete analysis and forecasting of risk adjustment intervention program values.
• Develop proficiency in running risk models including CMS models for Medicare Advantage, HHS model for Commercial ACA, CDPS model for Medicaid, etc.
• Strong attention to detail and knowledge of data structures and programming.
• Perform financial analysis to support healthcare management decisions.
• Apply best practices in data storage and sharing.
• Convert data into understandable insights to support strategic decisions.
• Research and develop reports for senior management; communicate results effectively.
• Gather and document report/analysis requirements; use peer reviews and end-user feedback to ensure quality.
• Exercise judgment independently, consult experts as needed, and utilize resources to critique results.
• Manage multiple projects and deliver results in a fast-paced, changing environment.

Job Qualifications

Required Education

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

Required Experience

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

Preferred Education

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

Preferred Experience

• Experience in Medical Economics and knowledge of performance indicators.
• Experience in risk adjustment initiatives, risk score lift, conditions captured, and program value analysis.
• Ability to analyze and forecast program value and population trends.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I is preferred.
• Familiarity with multiple data systems, models, and BI tools.

Current Molina employees interested in this position should apply through the intranet. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $125,000 annually. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industries: IT Services and IT Consulting

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