Sr Analyst, Healthcare Analytics - Risk Adjustment Data Modeler (REMOTE)

Company: Molina Healthcare
Location: Kennesaw
Posted on: September 24, 2022

Job Description:

JOB DESCRIPTION Job Summary This Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk score models with SQL, organizing and managing large and varied data sets, analyzing healthcare data for decision support, and communicating findings. Qualified candidates are the diligent problem solvers who have Risk Adjustment experience with advanced skills in SQL. Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data. Collaborates with actuarial and operational staff to analyze, understand, modify, and communicate models and results. Makes recommendations to management based on relevant findings. Knowledge/Skills/Abilities

• Compile and organize health care data using SQL programming, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
• Develop and demonstrate proficiency in maintaining all applicable risk score models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS+Rx model for Medicaid members, and others as needed
• Collect and document report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Use peer-to-peer review process and end-user consultation to reduce errors and rework
• Assist with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
• Create databases and reporting tools for monitoring, tracking and trending based on project specifications
• Must have a strong attention to detail and knowledge of data structure and programming
• Understanding data storage and data sharing methods
• Converting data into usable information that is easy to understand
• Research and develop reports and analysis for senior management and effectively communicate results 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
  • Bachelor's Degree in Finance, Economics, Math, or Computer Science Preferred Experience Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
    • Risk Adjustment experience and knowledge of risk score models - - -
    • Proactively identify and investigate complex suspect areas regarding medical cost issues
    • Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
    • Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
    • Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions
    • Healthcare Analyst I experience desired
    • Multiple data systems and models
    • BI tools - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. #PJCorp #LI-BEMORE

Keywords: Molina Healthcare, Atlanta , Sr Analyst, Healthcare Analytics - Risk Adjustment Data Modeler (REMOTE), Professions , Kennesaw, Georgia