Analyst, Health Plan Risk & Quality Reporting (Remote in New Mexico)

Molina Healthcare•Long Beach, CA

13d•Remote

About The Position

Provides analyst support for health plan risk and quality reporting activities. The Analyst designs and develops custom reports to support local interventions and provider outreach, tracks initiative outcomes, and educates users on risk and quality/HEDIS reports for Medicaid, Medicare, Marketplace, and Medicare/Medicare-Medicaid Plan (MMP) programs. The role also assists with research, development, and completion of special quality performance improvement projects, including root-cause analysis. The Analyst captures reporting requirements; builds custom, ad hoc, quality assurance, and intervention-strategy reports; monitors supplemental data and HEDIS performance; and calculates gap closure and intervention outcomes. The position analyzes complex managed-care datasets, including medical claims, pharmacy, laboratory, and HEDIS data, and collaborates with national risk and quality teams on pre-production testing. It also supports data warehouse platform changes, reporting module upgrades, and impact analyses while helping health plans improve performance on underperforming quality measures.

Requirements

At least 2 years of experience mapping, scrubbing, scraping, and cleaning data, with analysis experience related to HEDIS and/or risk adjustment, and 1 year of experience in a managed care organization, or an equivalent combination of relevant education and experience.
Analytical mindset with excellent attention to detail.
Experience working with complex data, including quantifying, measuring, and analyzing financial/performance management and utilization metrics.
Experience with Microsoft T-SQL, Databricks SQL, and Power BI.
Experience writing complex SQL queries, functions, procedures, and data designs.
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 and ability to connect data insights to strategic goals.
Self-starter with a continuous improvement mindset.
Effective verbal and written communication skills.
Proficiency with Microsoft Office, including advanced Excel, and applicable software programs.

Nice To Haves

Certified Professional in Healthcare Quality (CPHQ).
Certified HEDIS Compliance Auditor (CHCA).
Registered Nurse; if licensed, the license must be active and unrestricted in the state of practice.

Responsibilities

Capture and document health plan quality reporting requirements, build custom reports, and educate health plan users on their use.
Build intervention strategy reporting for risk and quality interventions and measure gap closure.
Build ad hoc quality reports to track HEDIS performance and supplemental data monitoring.
Develop quality assurance custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace, and Medicare/MMP.
Develop custom reports using managed care data, including medical claims, pharmacy, laboratory, and HEDIS rates.
Collaborate with the national risk and quality team to test pre-production reporting for the assigned health plan.
Calculate and track gap closure and intervention outcomes for the assigned health plan.
Analyze complex organizational datasets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
Conduct root-cause analysis for business data issues.
Analyze datasets and trends for anomalies, outliers, trend changes, and opportunities using Databricks SQL, Power BI, Microsoft Excel, and other techniques.
Assist with research, development, and completion of special quality-related projects requested by internal departments or in support of regulatory, contracting, or other external organizations.
Assist with testing data warehouse platform changes and perform transparent reporting module upgrades to avoid end-user impact.
Conduct preliminary and post-impact analyses of logic and source code changes for data and reporting modules, holding other non-focus variables constant.
Serve as a HEDIS subject matter expert and support health plan improvement on underperforming quality measures.