Sr Analyst, Healthcare Analytics - Risk Adjustment (REMOTE)

Lensa; Saint Petersburg (FL); Remote; USD 77,000 - 125,000; Full time

Job summary

A leading company in healthcare analytics is seeking a Sr. Analyst to join their Risk Adjustment Actuarial team. This role involves analyzing healthcare data, developing performance reports, and providing strategic insights to improve healthcare interventions. Candidates should have a strong background in data analysis, SQL, and financial metrics, with a Bachelor's degree in a relevant field.

Qualifications

• 5-7 years in complex database management and data analysis.
• Advanced SQL knowledge and proficiency in Excel.
• Experience in Medical Economics and healthcare analytics preferred.

Responsibilities

• Analyze healthcare claims data and evaluate program performance.
• Develop reports and present findings to senior management.
• Manage multiple projects in a fast-paced environment.

Skills

Data analysis

Healthcare analytics

SQL

Financial analysis

Data visualization

Education

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

Tools

Power BI

Tableau

Databricks

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

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.
• 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 of root cause analysis to ensure data integrity and minimize discrepancies.
• Creating databases and dashboards for monitoring, tracking, and trending, with automation where appropriate.
• Analysis and forecasting of risk adjustment intervention program values.
• Proficiency in running risk models for CMS Medicare Advantage, HHS Commercial ACA, Medicaid (CDPS), and others.
• Strong attention to detail and understanding of data structures and programming.
• Financial analysis to support healthcare management and decision-making.
• Applying best practices in data storage and sharing.
• Transforming data into actionable insights for strategic investments.
• Developing reports and analyses for senior management, communicating results clearly.
• Gathering and documenting report requirements, reviewing outputs, and reducing errors.
• Practicing sound judgment, consulting experts, and utilizing resources effectively.
• 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 in complex database management and data analysis.
• Experience quantifying and analyzing healthcare financial and utilization metrics.
• Advanced SQL knowledge.
• Proficiency in Excel and visualization tools like Power BI or Tableau.

Preferred Education

Bachelor’s in Finance, Economics, Math, or Computer Science.

Preferred Experience

• Experience in Medical Economics and knowledge of performance indicators.
• Ability to investigate complex risk adjustment issues and recommend corrective actions.
• Skills in healthcare analytics, predictive modeling, and population trend analysis.
• Experience as Healthcare Analyst I or Financial/Accounting Analyst I.
• Experience with multiple data systems, models, and BI tools.

Current Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Additional Details

• Pay Range: $77,969 - $125,000 annually.
• Seniority Level: Mid-Senior level.
• Employment Type: Full-time.
• Job Function: Healthcare Provider.
• Industries: IT Services and Consulting.