Senior Analyst, National Quality Analytics & Performance - Medicare Star Reporting (Remote)

Job Description

Molina Healthcare Job ID 2037981

Essential Job Duties

• Collaborates cross-functionally with internal departments across the enterprise to capture and document quality-related reporting requirements; builds reporting solutions, and educates users on how to use reports.
• Affords assistance to quality data analytics leaders in predictive intervention strategic analytics, and corresponding tracking of progress and impact of interventions.
• Affords assistance with retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develops medical record review project reporting to track progress and team productivity reporting.
• Develops quality assurance (QA) reporting and automated analytical reporting modules for the Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Analyzes and reports managed care data including claims, pharmacy, lab and HEDIS rates.
• Affords assistance to quality department with HEDIS measure deep dives to support HEDIS audit and revenue at risk reporting.
• Calculates and tracks HEDIS rates for all intervention outcomes for all markets and lines of business.
• Works in an agile business environment to derive meaningful information out of complex/large data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities using statistical tools and techniques to determine significance and relevance; utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
• Affords assistance with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
• Tracks, facilitates and manages changes in the data warehouse platform and performs transparent upgrades to analytic reporting modules to ensure no impact to end-users.
• Conducts preliminary and post-impact analyses for any logic and source code changes for data analytics and reporting module, keeping other variables as constant that are not of focus.
• Represents as a HEDIS subject matter expert; supports health plans improve on underperforming quality measures.
• Completes special quality data-related projects as assigned.
• Provides training and support to new and existing data analytics/reporting team members.

Required Qualifications

• At least 4 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI, and at least 2 years of experience in a managed care organization, in addition to predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.
• An analytical mindset, excellent attention to detail, and problem-solving skills.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Strong business acumen with the ability to connect data insights to strategic goals.
• Ability to communicate complex analytical results clearly to non-technical audiences.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency.

Preferred Qualifications

• Familiarity with data science techniques and languages like Python and R programming.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.