Job Details

Job Summary

The Quality Analytics and Performance Improvement Analyst will play a crucial role in supporting Molina's Quality Analytics team. This position involves designing and developing comprehensive reporting solutions that assist with HEDIS audits, rate tracking, and identifying targeted interventions while tracking outcomes related to performance metrics.

Essential Job Duties:

• Collaborate cross-functionally with various departments to capture and document reporting requirements, develop reporting solutions, and provide training on report usage.

• Support Quality Data Analytics Leaders in the Predictive Intervention Strategy Analytics, as well as tracking the progress and impact of implemented interventions.

• Assist with retrospective HEDIS rate tracking and supplemental data impact reporting.

• Develop reporting for Medical Record Review projects to monitor progress and team productivity.

• Contribute to the development and quality assurance of automated and ad-hoc analytical reporting modules related to Quality/HEDIS for Medicaid, Marketplace, and Medicare/MMP.

• Analyze managed care data, including Medical Claims, Pharmacy, Lab, and HEDIS rates.

• Assist the Quality department with in-depth analysis of HEDIS measures to support audits and revenue-risk reporting.

• Calculate and track HEDIS rates for intervention outcomes across various markets and lines of business.

• Utilize data analysis and mining techniques in an agile environment to derive meaningful insights from complex data sets through verification, scrubbing, and root cause analysis.

• Conduct root cause analysis for business data issues as assigned by the team lead.

• Identify anomalies, outliers, and trends in data sets using statistical tools; apply methodologies such as extrapolation and interpolation to forecast future trends in cost, utilization, and performance.

• Assist in the research, development, and completion of special projects requested by internal departments or in support of regulatory and contracting agencies.

Job Qualifications

Required Education:

Bachelor's Degree in Computer Science, Finance, Math, Economics, or a related field.

Required Experience:

• 3+ years of experience in data mapping, scrubbing, and cleaning.

• 3+ years in a Managed Care Organization executing a techno-functional role with complex SQL Queries, Functions, Procedures, and Data design.

• 3+ years with Microsoft T-SQL, SSIS, and SSRS.

• Familiarity with data science techniques and programming languages such as Python and R is a plus.

• Experience with Microsoft Azure, AWS, or Hadoop is advantageous.

• 1-3 years of experience in predictive modeling within healthcare quality data.

• 1-3 years in analyzing HEDIS rate tracking, Medical Record Review tracking, and Interventions tracking for at least one line of business among Medicaid, Marketplace, and Medicare/MMP.

• 1-3 years in handling complex data challenges related to financial and performance management metrics.

• 1-3 years in statistical analysis and forecasting of HEDIS trends to provide analytic insights for quality, finance, and health plan functions.

Physical Demands:

The working environment is generally favorable with adequate lighting and temperature. Work is primarily performed in an office setting with minimal exposure to unpleasant or hazardous conditions. Must be able to sit for extended periods. Reasonable accommodations are available for individuals with disabilities to perform essential functions.

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

Pay Range: $80,168 - $128,519 / ANNUAL

*Compensation may vary based on geographic location, work experience, education, and/or skill level.