Risk Adjustment Audit Operations Analyst - RADV

Job Description

Job Summary

The Junior Analyst will play a supporting role on the RADV (Risk Adjustment Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase lists by helping identify and validate source data required for medical record collection.

This is an ideal opportunity for an early-career analyst with a strong interest in healthcare data, regulatory processes, and cross-functional collaboration. Success in this role requires curiosity, attention to detail, and a willingness to engage with complex datasets across varied systems. The analyst will work closely with experienced team members and internal partners to gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts.

Knowledge/Skills/Abilities

• Assist with the identification and validation of data sources needed to support RADV audit cycles.
• Support the generation of chart retrieval chase lists based on CMS audit samples and internal data logic.
• Use SQL and other analytical tools within Databricks to explore datasets and confirm required data elements.
• Collaborate with internal teams—including IT, Risk Adjustment operations, and clinical teams—to ensure accurate and consistent data interpretation.
• Help translate CMS audit requirements into data tasks under the guidance of senior analysts.
• Document data sourcing steps, methodologies, and business rules to promote traceability and team learning.
• Participate in internal simulations and mock audits as part of proactive audit readiness.
• Contribute to the investigation of data inconsistencies and help gather context for issue resolution.
• Communicate progress and findings clearly with project leads and teammates in a collaborative environment.

Job Qualifications

Required Education

• Bachelor’s degree or equivalent experience in a relevant field (e.g., Health Informatics, Public Health, Computer Science, Statistics)

Required Experience

• 0–2 years of experience in data analytics, business intelligence, or healthcare operations
• Foundational proficiency in SQL and exposure to Python or another programming language
• Basic familiarity with healthcare data types such as claims, encounters, or eligibility data
• Comfortable working with data in spreadsheets or analytical platforms
• Eagerness to learn, ask questions, and contribute to team problem-solving
• Strong attention to detail and an interest in audit or regulatory workflows

Preferred Experience

• Internship or academic project experience related to healthcare data or analytics
• Exposure to Databricks, Spark, or similar data platforms
• Familiarity with Medicare Advantage or Medicaid programs
• Awareness of CMS audit processes or healthcare compliance requirements

Ideal Candidate Attributes

• Curious and Eager to Learn: Interested in understanding healthcare data and willing to dig into unfamiliar topics.
• Team-Oriented: Works well in a collaborative environment and seeks input from more experienced colleagues.
• Detail-Focused: Takes pride in accuracy and thoroughness when working with data.
• Adaptable: Comfortable navigating ambiguity and shifting project needs with support from the team.

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.

Pay Range: $77,969 - $128,519 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.