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

Molina Healthcare•Long Beach, NM

12d•Remote

About The Position

Provides analyst support for health plan risk and quality reporting activities. Designs and develops custom health plan reports to support local interventions and provider outreach, and tracks initiative outcomes. Educates users on reports related to risk and quality/HEDIS for Medicaid, Medicare, Marketplace, and Medicare/Medicare-Medicaid Plan (MMP). Assists with research, development, and completion of special quality performance improvement projects, including root-cause analysis.

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 and 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 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 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 how to use them.
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 health plan reports involving managed care data, including medical claims, pharmacy, lab, and HEDIS rates.
Collaborate with the national risk and quality team on pre-production reporting tests for the assigned health plan.
Calculate and track gap closure and intervention outcomes for the assigned health plan.
Analyze complex organizational datasets using data analysis, data mining, verification, data scrubbing, and root-cause analysis.
Conduct root-cause analysis for business data issues.
Analyze datasets and trends for anomalies, outliers, changes, and opportunities using Databricks SQL, Power BI, Microsoft Excel, and techniques to determine significance and relevance.
Assist with special quality-related projects requested by internal departments or in support of regulatory agencies, contracting agencies, or other external organizations.
Support testing of changes to the Datawarehouse platform and transparently upgrade reporting modules to avoid end-user impact.
Conduct preliminary and post-impact analyses of logic and source-code changes for data and reporting modules while keeping non-focus variables constant.
Serve as a HEDIS subject matter expert and support health plan improvement on underperforming quality measures.