Lead Analyst, Quality Analytics & Performance Improvement

Role Description

The Lead Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and identifying targeted interventions and tracking outcomes. Assists with research, development, and completion of special performance improvement projects. Provides technical, functional, and business training to other team members to enable them to perform the tasks required.

• 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 and 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.

Qualifications

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

Requirements

• Working environment is generally favorable and lighting and temperature are adequate.
• Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions.
• Must have the ability to sit for long periods.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

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