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Lead Predictive Analytics for Risk AdjustmentMolina Healthcare • United States
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Lead Predictive Analytics for Risk Adjustment

Molina Healthcare
  • US
    United States
  • US
    United States
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À propos

Job Description Job Summary As a Lead Predictive Analytics for Risk Adjustment, you will play a crucial role in driving Molina's Risk Adjustment Predictive Analytics team. You will be responsible for designing and developing systems that enhance our Prospective and Retrospective Interventions. Additionally, you will provide essential training to empower team members to perform their duties effectively. Knowledge/Skills/Abilities Support Risk Adjustment Data Analytics Leaders in analyzing and strategizing Prospective and Retrospective Intervention efforts while tracking their progress and effectiveness. Create and implement ad-hoc and automated analytical modules related to Risk Adjustment for Medicaid, Marketplace, and Medicare/MMP. Collaborate with Risk Adjustment Data Analytics Leaders to design and develop an Automated Suspect and Target/Ranking Engine across all lines of business. Conduct data analysis and reporting on Managed Care data, including Medical Claims, Pharmacy, Lab, and financial data such as risk scores, revenue, and costs. Perform root cause analysis for business data issues, summarizing findings and solutions for leadership. Design and lead the development of systems to track risk scores for intervention outcomes across all markets and lines of business. Work in an agile environment to extract meaningful insights from complex, large organizational data sets through comprehensive data analysis, mining, and verification. Engage with stakeholders at various levels to clarify business requirements, data points, and necessary escalations. Analyze data sets for anomalies, trends, and opportunities, applying statistical techniques to forecast future trends in cost, utilization, and performance. Present executive summaries of your findings. Assist in research and completion of special projects at the request of internal departments or external regulatory and contracting organizations. Stay updated with CMS/State regulations pertinent to Risk Adjustment Analytics, providing training to the team and management as necessary. Manage changes in the Datawarehouse platform, ensuring seamless upgrades to analytics reporting modules to avoid any end-user impact. Conduct analyses before and after logic or source code changes in data analytics and reporting modules while maintaining other variables constant. Create training modules to enhance analysts' understanding of processes, solutions, or designs to respond to customer requests. Foster a team culture that embraces an agile environment and encourages a positive approach to challenging, time-sensitive projects. Take accountability for assigned tasks and projects. Job Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Math, Economics, or a related field. Required Experience 6+ years of experience in data mapping, scrubbing, scraping, and cleaning. 5+ years of experience in a Managed Care Organization in a techno-functional role involving complex SQL Query writing, Functions, Procedures, and Data Design. 5+ years of experience with Microsoft T-SQL, SSIS, and SSRS. Familiarity with Data Science techniques and programming languages like Python and R is a plus. 5+ years of experience analyzing Risk Scores, Encounter Submissions, and Payment Models within Medicaid, Marketplace, or Medicare/MMP. 5+ years of experience in Prospective, Retrospective, and Audit targeting Analytics and Reporting. 5+ years handling complex data issues with a focus on financial/performance management and utilization metrics. 5+ years of experience in Statistical Analysis and forecasting trends in medical costs to support finance, pricing, and actuarial functions. PHYSICAL DEMANDS The working environment is generally favorable, with adequate lighting and temperature. Work is typically performed in an office setting with minimal exposure to unpleasant conditions. The ability to sit for extended periods is required. Reasonable accommodations will be provided to enable individuals with disabilities to perform essential functions. To all current Molina employees: If you are interested in this position, please apply through the intranet job listing. Molina Healthcare offers an attractive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,412 - $188,164 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.
  • United States

Compétences linguistiques

  • English
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