Analyst, National Quality Analytics & Performance Improvement

Role Description

Provides analyst support for Molina enterprise risk and quality reporting activities. Designs and develops reporting solutions to support Healthcare Effectiveness Data and Information Set (HEDIS) auditing, rate tracking, identification of targeted interventions, and performance metric outcome tracking. Collects, validates, analyzes, and organizes data into meaningful reports for operational/strategic analysis and decision-making.

• Collaborates cross-functionally with internal departments across the enterprise to capture and document quality-related reporting requirements; builds reporting solutions, and educates users on how to use reports.
• Assists quality data analytics leaders in predictive intervention strategic analytics, and corresponding tracking of progress and impact of interventions.
• Assists with retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develops medical record review project reporting to track progress and team productivity reporting.
• Develops quality assurance (QA) reporting and automated analytical reporting modules for the Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Analyzes and reports managed care data including claims, pharmacy, lab and HEDIS rates.
• Assists quality department with HEDIS measure deep dives to support HEDIS audit and revenue at risk reporting.
• Calculates and tracks HEDIS rates for all intervention outcomes for all markets and lines of business.
• Works in an agile business environment to derive meaningful information out of complex/large 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 statistical tools and techniques to determine significance and relevance; utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
• 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.

Qualifications

• At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI.
• At least 1 year of experience in a managed care organization, in addition to predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.
• Analytical mindset, excellent attention to detail, and problem-solving skills.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working 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 with the ability to connect data insights to strategic goals.
• Ability to communicate complex analytical results clearly to non-technical audiences.
• Self-starter with a continuous improvement mindset.
• Effective verbal and written communication skills.
• Microsoft Office suite proficiency.

Preferred Qualifications

• Familiarity with data science techniques and languages like Python and R programming.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.