Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Owensboro (KY); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading company is seeking a Sr. Analyst in Healthcare Analytics to join their Risk Adjustment Actuarial team. This remote role involves analyzing healthcare data, developing performance reports, and making strategic recommendations. The ideal candidate will have extensive experience in database management and healthcare analytics, with a strong focus on data integrity and financial analysis. Join a dynamic team committed to improving healthcare outcomes through data-driven insights.

Qualifications

• 5-7 years of experience in database and data management.
• Healthcare experience in financial and utilization metrics.

Responsibilities

• Research and analyze healthcare claims and data.
• Develop and present program performance reports.
• Perform financial analysis for healthcare management.

Skills

Data Analysis

Healthcare Analytics

Attention to Detail

Root Cause Analysis

Education

Bachelor's Degree in Finance

Bachelor's Degree in Economics

Bachelor's Degree in Computer Science

Tools

SQL

Power BI

Tableau

Databricks

Spark SQL

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 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, including:

• Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value.
• Initiate in-depth analysis of suspect/problem areas and suggest corrective actions.
• Apply investigative skills and analytical methods to assess business impacts and make recommendations using healthcare analytics and predictive modeling.
• Analysis and forecasting of program value and population trends in risk adjustment to support finance, pricing, and actuarial functions.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I is desired.
• Experience with multiple data systems and models.
• Data modeling and BI tools.

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

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

Additional Details

Pay Range: $77,969 - $155,508 / ANNUAL. Actual compensation may vary based on location, experience, education, and skills.