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Data Analyst - Risk Adjustment Insights
Molina Healthcare
- United States
- United States
Über
Develop and perform quality assurance on both ad-hoc and automated analytical tools and reporting modules related to Medicaid, Marketplace, and Medicare/MMP risk adjustments.
Help create an automated Suspect and Target/Ranking Engine to optimize performance across all lines of business.
Conduct comprehensive analysis and reporting of managed care data, including medical claims, pharmacy, lab, and associated financial metrics such as risk scores, revenue, and costs.
Calculate and monitor risk scores for intervention outcomes and overall markets and lines of business.
Work in a dynamic environment to extract meaningful insights from complex datasets through thorough data analysis, mining, verification, and issue resolution.
Perform root cause analysis on business data issues as directed by the team lead.
Examine data trends for anomalies and opportunities using statistical tools and techniques to assess significance and relevance, predicting future trends in costs and performance.
Assist with research and completion of special projects in support of internal and external requests, including regulatory and contracting agencies.
Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Mathematics, Economics or equivalent field. Required Experience 1-3 years experience in data mapping, cleaning, and analysis.
1-3 years in a managed care organization leveraging complex SQL queries and data design.
1-3 years working with Microsoft T-SQL, SSIS, and SSRS.
Familiarity with Data Science techniques and languages such as Python and R is a plus.
1-3 years analyzing risk scores and payment models in at least one business line: Medicaid, Marketplace, or Medicare/MMP.
1-3 years in prospective/retrospective audit targeting analytics and reporting.
1-3 years managing complex data problems and analyzing financial and performance metrics.
1-3 years conducting statistical analysis to forecast medical cost trends.
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: $44,936.59 - $97,362.61 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.
Sprachkenntnisse
- English
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