Molina Healthcare

Senior Analyst, Risk & Quality Reporting - HEDIS

Molina Healthcare$85K — $110K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree or equivalent combination of education and work experience
  • 3-5 years of experience in data mapping, scrubbing, and cleaning
  • 3-5 years of experience in a Managed Care Organization in a similar techno-functional role
  • 3-5 years of experience with Microsoft T-SQL, Databricks SQL, and PowerBI
  • 1-3 years of experience with Microsoft Azure, AWS, or Hadoop
  • 3-5 years in HEDIS and/or Risk Adjustment analysis
  • 3-5 years of experience in working with complex data for financial and performance management

Responsibilities

  • Capture and document requirements to build custom health plan reports
  • Build intervention strategy reporting for Risk and Quality measures
  • Develop ad hoc reports to track HEDIS performance
  • Conduct quality assurance on custom health plan reports for Medicaid and Medicare
  • Collaborate with national teams on pre-production reporting testing
  • Calculate and track intervention outcomes and gap closures
  • Analyze complex data sets for trends and anomalies using SQL, PowerBI, and Excel

Benefits

  • Comprehensive benefits package
  • Opportunities for professional development
  • Supportive work environment focused on teamwork
  • Participation in performance improvement initiatives
  • Flexible working conditions to enhance work-life balance
Full Job Description
Job Description

Job Description

Job Summary

The Sr Analyst, Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of the initiatives. Educates users on how to use reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. Assists with research, development, and completion of special performance improvement projects including root cause analysis.

Job Duties
  • Works with assigned health plan to capture and document requirements, build custom health plan reports, and educate health plan users on how to use reports
  • Builds intervention strategy reporting for the Risk and Quality interventions and measures gap closure
  • Builds ad hoc reports as requested to track HEDIS performance and supplemental data monitoring
  • Develops and QA custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP
  • Develops custom health plan reports related to managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates
  • Assists and collaborates with the national Risk and Quality department with testing of pre-production reporting for the assigned health plan
  • Calculates and tracks gap closure and intervention outcome reporting for the assigned state
  • Works in an agile business environment to derive meaningful information out of complex and large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis
  • Conducts root cause analysis for business data issues
  • Analyzes data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks SQL, PowerBi, excel, and techniques to determine significance and relevance
  • Assists 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
  • Key partner to assist with testing changes in the Datawarehouse platform and perform transparent upgrades to reporting modules to ensure no impact to the end users
  • Conducts preliminary and post impact analyses for any logic and source code changes for data and reporting module keeping other variables as constant that are not of focus
  • Develops oneself as a HEDIS subject matter expert to help health plan improve performance on underperforming measures


Job Qualifications

REQUIRED QUALIFICATIONS:
  • Bachelor's Degree or equivalent combination of education and work 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 working with Microsoft T-SQL, Databricks SQL and PowerBI
  • 1-3 years of experience with Microsoft Azure, AWS, or Hadoop
  • 3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment
  • 3-5 years of experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics


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

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
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ

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