Senior Analyst, Risk & Quality Reporting - HEDIS

Job Description

Job Summary

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.

Job Duties

• 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

Job Qualifications

REQUIRED QUALIFICATIONS:

• 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

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing

Molina Healthcare offers a competitive benefits and compensation package Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V