About the position
The Sr Analyst, Risk and Quality Reporting role supports Molina’s Risk and
Quality Health Plan team. Designs and develops custom health plan reports to
support local interventions, provider outreach, and tracks outcomes of the
initiatives. Educates users on how to use reports related to Risk and
Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. Assists with research,
development, and completion of special performance improvement projects
including root cause analysis.
Responsibilities
• Works with assigned health plan to capture and document requirements, build
custom health plan reports, and educate health plan users on how to use
reports
• Builds intervention strategy reporting for the Risk and Quality interventions
and measures gap closure
• Builds ad hoc reports as requested to track HEDIS performance and
supplemental data monitoring
• Develops and QA custom health plan reports related to Risk and Quality/HEDIS
for Medicaid, Marketplace and Medicare/MMP
• Develops custom health plan reports related to managed care data like Medical
Claims, Pharmacy, Lab and HEDIS rates
• Assists and collaborates with the national Risk and Quality department with
testing of pre-production reporting for the assigned health plan
• Calculates and tracks gap closure and intervention outcome reporting for the
assigned state
• Works in an agile business environment to derive meaningful information out
of complex and large organizational data sets through data analysis, data
mining, verification, scrubbing, and root cause analysis
• Conducts root cause analysis for business data issues
• Analyzes data sets and trends for anomalies, outliers, trend changes, and
opportunities, using databricks SQL, PowerBi, excel, and techniques to
determine significance and relevance
• Assists 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
• Key partner to assist with testing changes in the Datawarehouse platform and
perform transparent upgrades to reporting modules to ensure no impact to the
end users
• Conducts preliminary and post impact analyses for any logic and source code
changes for data and reporting module keeping other variables as constant
that are not of focus
• Develops oneself as a HEDIS subject matter expert to help health plan improve
performance on underperforming measures
Requirements
• Bachelor's Degree or equivalent combination of education and work experience
• 3-5 years of experience in working with data mapping, scrubbing, scrapping,
and cleaning of data
• 3-5 years of experience in Managed Care Organization executing similar techno
functional role that involves writing complex SQL Queries, Functions,
Procedures and Data design
• 3-5 years of experience working with Microsoft T-SQL, Databricks SQL and
PowerBI
• 1-3 years of experience with Microsoft Azure, AWS, or Hadoop
• 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment
• 3-5 years of experience in working with complex data to include quantifying,
measuring, and analyzing financial/performance management and utilization
metrics
Benefits
• Molina Healthcare offers a competitive benefits and compensation package
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