Job Details

Job Description

Job Description

Job Summary

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcomes on performance metrics.

ESSENTIAL JOB DUTIES:

• Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports.
• Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions.
• Assist retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develop Medical Record Review project reporting to track progress and team productivity reporting.
• Development and QA of ad-hoc as well as automated analytical Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates.
• Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting.
• Calculate and track HEDIS rates for all intervention outcome and for overall markets and LOB.
• Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis.
• Do root cause analysis for business data issues as assigned by the team lead.
• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
• Assist 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.

Job Qualifications

REQUIRED EDUCATION:

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline

REQUIRED EXPERIENCE:

• 3+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data.
• 3+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
• 3+ years of experience in working with Microsoft T-SQL, SSIS and SSRS.
• Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage.
• Familiarity with Microsoft Azure, AWS or Hadoop.
• 1-3 Years of experience with predictive modeling in healthcare quality data.
• 1-3 Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP.
• 1-3 Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• 1-3 Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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.