Molina Healthcare

Lead, Risk Adjustment - Predictive Analytics

Molina Healthcare • $90K — $120K *
Bellevue, NE 68123In-Person
Healthcare
5 - 7 years of experience
More than 3 months ago
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Computer Science, Finance, Math, Economics, or equivalent discipline.
  • 6+ years of experience in data mapping, scrubbing, and cleaning.
  • 5+ years in a Managed Care Organization with complex SQL queries, functions, and data design.
  • 5+ years of experience with Microsoft T-SQL, SSIS, and SSRS.
  • 5+ years analyzing risk scores and encounter submissions for Medicaid, Marketplace, or Medicare/MMP.

Responsibilities

  • Assist leaders in strategy analytics for risk adjustment interventions.
  • Design and develop analytical modules for Risk Adjustment across various lines of business.
  • Lead the development of automated ranking engine for suspect and target identification.
  • Analyze managed care data metrics like claims and pharmacy for financial insights.
  • Conduct root cause analysis for data issues and report findings to leadership.

Benefits

  • Competitive benefits and compensation package.
  • Opportunities for professional development and training.
Full Job Description
Job Description

Job Description

Job Summary

The Lead, Risk Adjustment - Predictive Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to support Molina's Prospective and Retrospective Interventions. Provides technical, functional and business training to other team members to enable them to perform the tasks required.

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.
  • Design and development ad-hoc as well as automated analytical 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.
  • Conduct root cause analysis for business data issues, report to leadership the summary of findings and resolutions.
  • Design and lead development of tracking system for 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.
  • Work directly with interdepartmental / intradepartmental stakeholders along with Molina Executives to establish/deliver/explain the business requirement as well as data/data points and do necessary escalation as required.
  • 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.
  • Act as a subject matter expertise by following CMS/State regulations related to Risk adjustment Analytics and provide training as required. Stay current with industry regulation changes and educate the team and management as necessary.
  • Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytics 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 training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff.
  • Provide technical, functional and business training to other team members to enable them to perform the tasks required.
  • Maintain a team culture to adopt fast faced agile environment and foster a positive attitude to take on challenging and time sensitive projects.
  • Take accountability of tasks and projects assigned.


Job Qualifications

Required Education

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

Required Experience
  • 6+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data.
  • 5+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
  • 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.
  • 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.
  • 5+ Years of experience in Prospective/Retrospective/Audit targeting Analytics and Reporting.
  • 5+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
  • 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.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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