Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Mesa (AZ); Remote; USD 77,000 - 125,000; Full time

Job summary

A leading healthcare analytics company is seeking a Sr. Analyst to join their Risk Adjustment Actuarial team. The role involves analyzing healthcare data, developing reports, and providing insights to improve healthcare programs. Ideal candidates will have strong SQL skills and experience in financial analysis within the healthcare sector.

Qualifications

• 5-7 years of experience in database management and financial metrics analysis.
• Strong SQL knowledge and proficiency in Excel and visualization tools.

Responsibilities

• Responsible for program valuation and analysis of healthcare claims data.
• Develops reports and forecasts for healthcare intervention program performance.

Skills

Data Analysis

Financial Analysis

SQL

Attention to Detail

Healthcare Analytics

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)

1 day ago Be among the first 25 applicants

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 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 ROI, 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 SAIs, 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, SSIS, and other tools.
• Reporting includes program performance metrics, risk score and revenue impact, tracking of SAIs, forecasts, and deep dives for financial improvement.
• Ownership of root cause analysis to ensure data integrity and minimize discrepancies.
• Creating databases and dashboards for monitoring, tracking, and trending, with automation as needed.
• Analysis and forecasting of risk adjustment program values.
• Proficiency in running risk models for Medicare Advantage, Commercial ACA, Medicaid, and other models.
• Strong attention to detail, data structure, and programming knowledge.
• Financial analysis to support healthcare management decisions.
• Applying data storage and sharing best practices.
• Converting data into understandable insights for strategic decisions.
• Developing reports and analyses for senior management, communicating results effectively.
• Gathering and documenting report requirements, peer review, and end-user consultation.
• Practicing independent judgment, consulting experts, and utilizing resources.
• 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.
• 5-7 years of experience in quantifying, measuring, and analyzing financial/performance metrics.
• Healthcare experience in quantifying, measuring, and analyzing financial and utilization metrics.
• 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.
• Investigative skills in risk adjustment initiatives, risk score lift, and program value.
• In-depth analysis of suspect areas with corrective actions.
• Use of healthcare analytics and predictive modeling.
• Forecasting program value and population trends.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I.
• Experience with multiple data systems, models, and BI tools.

To all current Molina employees: Apply through the intranet.

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

#PJCorp

Pay Range: $77,969 - $125,000 / 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