Lead Analyst, Quality Analytics & Performance Improvement (Remote)

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

The Lead Analyst, Quality Analytics and Performance Improvement role supports Molina's Quality Analytics team. This position is responsible for designing and developing reporting solutions to aid HEDIS audit, rate tracking, and identifying targeted interventions and tracking their outcomes. The role also involves assisting with research, development, and completion of special performance improvement projects. A key aspect of the role is providing technical, functional, and business training to other team members. The analyst will work cross-functionally to gather requirements, build reporting solutions, and educate users. Specific duties include assisting with predictive intervention strategy analytics, designing retrospective HEDIS rate tracking, developing Medical Record Review project reporting, and leading the development of ad-hoc and automated analytical/reporting modules for Medicaid, Marketplace, and Medicare/MMP. The role requires analyzing and reporting on managed care data (Medical Claims, Pharmacy, Lab, HEDIS rates), performing HEDIS measure deep dives, calculating and tracking HEDIS rates, and working with complex organizational data sets through analysis, data mining, verification, scrubbing, and root cause analysis. The analyst will use statistical tools to identify trends, anomalies, and opportunities, and predict future trends. Additionally, the role involves acting as a subject matter expert in HEDIS reporting, staying current with NCQA standards, managing data warehouse platform changes, conducting impact analyses, and developing training modules.

Requirements

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline
6+ Years of experience in working with data mapping, scrubbing, scrapping and cleaning of data.
6+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
6+ years of experience in working with Microsoft T-SQL, SSIS and SSRS.
3+ years of experience with Microsoft Azure, AWS or Hadoop.
4+ Years of experience with predictive modeling in healthcare quality data.
4+ 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.
4+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
4+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions

Nice To Haves

Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage.

Responsibilities

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.
Design and develop retrospective HEDIS rate tracking and supplemental data impact reporting.
Develop Medical Record Review project reporting to track progress and team productivity reporting.
Lead Design and Development of ad-hoc as well as automated analytical as well as 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 outcomes 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.
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.
Act as a subject matter expert in HEDIS reporting and provide trainings as required.
Stay current with NCQA standards and educate team as well as health plan analysts as needed.
Lead initiatives 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.
Track, Facilitate and Manage changes in the Data warehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users.
Conduct 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.
Develop training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff.
Provide technical, functional, and business trainings to internal and external team members to enable them to perform the required tasks.
Assist health plans building reporting solutions to perform successful member and provider interventions.