Modeling

Molina Healthcare•Long Beach, AZ

16h

About The Position

Job Summary The Senior Analyst, Clinical Data Acquisition Molina's Quality team. Responsible for data analysis for prospective and retrospective Quality, Risk Adjustment and RADV programs. Design and develop strategic data solutions to improve the data quality and utilization of provider and historical data to enhance performance of Medical Record Review. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Design and develop reporting to drive initiatives prompting provider engagement and reducing manual interventions across the Clinical Data Acquisition team. Assist with research, development, and completion of special performance improvement projects.

Requirements

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline
5+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data.
5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
5+ years of experience in working with Microsoft T-SQL, SSIS and SSRS.
3+ years of experience with Microsoft Azure, AWS, or Hadoop.
3+ Years of experience with predictive modeling in healthcare quality data.
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.
3+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
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

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.
Assist retrospective HEDIS rate tracking and supplemental data impact reporting.
Develop provider and medical record collection data clean up methodology and logic to streamline Medical Record Review execution.
Develop Medical Record Review project reporting to track progress, team productivity reporting and staffing models for Quality and Risk Adjustment initiatives
Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS and Risk Adjustment for Medicaid, Marketplace and Medicare/MMP.
Perform strategic data mining to identify gaps in provider performance and participation and aid in identification of improvement solutions.
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.
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.
Track, Facilitate and Manage changes in the Datawarehouse 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 oneself as HEDIS and Risk Adjustment subject matter expert to help health plan improve performance on underperforming measures and unsupported diagnosis codes