Skip to main content

Search Jobs
Search

Let us search jobs for you based on the skills and experience listed in your LinkedIn profile.

Start Matching Jobs
close message

ATTENTION JOB SEEKERS AND MOLINA APPLICANTS: FRAUD ALERT

Be aware that third parties posing as Molina Healthcare may be soliciting money from job seekers and extending offers to candidates who have not interviewed. Molina does not engage in these type of practices. If you have received an offer and have not been engaging with Molina Healthcare in an interview process, reach out to erc@molinahealthcare.com to validate the legitimacy of your offer. Please note that Molina has reported this activity to the appropriate law enforcement agencies for further investigation. If you feel you’ve been victimized, please report it to local law enforcement.

Sr Analyst, Risk Adj-Predictive Analytics - Databricks/SQL - Remote

Molina Healthcare United States; Louisville, KY; Lexington, KY; Bowling Green, KY; Owensboro, KY; Covington, KY; Georgetown, KY; Richmond, KY; Florence, KY; Nicholasville, KY Job ID 2027585
Apply Now
Job Description


Job Summary

The Sr Analyst, Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to suport Molina's Prospective and Retrospective Interventions. Assist with research, development,and completion of special projects.

Knowledge/Skills/Abilities

  • Assist Risk Adjustment Data Analytics Leaders in Prospective and Retrospective Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions.
  • Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Risk Adjustment for Medicaid, Marketplace and Medicare/MMP.
  • Assist Risk Adjustment Data Analytics Leaders in designing and developing Automated Suspect and Target/Ranking Engine for all line of businesses.
  • Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related financial data like risk score, revenue and cost.
  • Calculate and track risk scores for all intervention outcome 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.
  • Conduct root cause analysis for business data issues as assigned by the team lead.
  • 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. Provide executive summary of findings to requestors.
  • Assist 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 Datawarehouse 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 oneself as subject matter expertise by following CMS/State regulations related to Risk adjustment Analytics.

Job Qualifications

Required Education

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline

Required 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 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.
  • 3-5 Years of experience in Analysis related to Risk Scores, Encounter Submissions, Payment Models for at least one line of business among Medicaid, Marketplace and Medicare/MMP.
  • 3-5 Years of experience in Prospective/Retrospective/Audit targeting Analytics and Reporting.
  • 3-5 Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
  • 3-5 Years of experience in Statistical Analysis and forecasting of trends in medical costs to provide analytic support for finance, pricing and actuarial functions

PHYSICAL DEMANDS

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 function.

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: $59,810.6 - $129,589.63 / 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.

Job Type: Full Time Posting Date: 08/16/2024

ABOUT OUR LOCATION

View Map

Job Alerts

Sign up to receive automatic notices when jobs that match your interests are posted.

By uploading your resume you are not submitting an application for employment

Interested InSelect a job category from the list of options. Search for a location and select one from the list of suggestions. Finally, click “Add” to create your job alert.

  • Quality and Risk Adjustment, United StatesRemove
  • Quality and Risk Adjustment, Louisville, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Lexington-Fayette, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Bowling Green, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Owensboro, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Covington, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Georgetown, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Richmond, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Florence, Kentucky, United StatesRemove
  • Quality and Risk Adjustment, Nicholasville, Kentucky, United StatesRemove