Lead, Risk Adj-Pred Analytics - Python Scripting/SQL/Databricks - Remote

Molina Healthcare

436d • $80,412 - $188,164 • Remote

About The Position

The Lead, Risk Adjustment - Predictive Analytics role at Molina Healthcare is responsible for supporting the Risk Adjustment Predictive Analytics team by designing and developing systems for tracking and analyzing risk adjustment data. This position involves providing training to team members, conducting data analysis, and collaborating with various stakeholders to ensure effective intervention strategies are implemented. The role requires a strong background in data analytics, SQL, and statistical analysis, particularly in the context of managed care organizations.

Requirements

• Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline.
• 6+ years of experience in data mapping, scrubbing, and cleaning of data.
• 5+ years of experience in a Managed Care Organization executing a techno-functional role involving complex SQL queries and data design.
• 5+ years of experience with Microsoft T-SQL, SSIS, and SSRS.
• Familiarity with Data Science Techniques and languages like Python and R programming is preferred.
• 5+ years of experience in analysis related to Risk Scores, Encounter Submissions, and 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 analyzing financial/performance management and utilization metrics.
• 5+ years of experience in Statistical Analysis and forecasting of trends in medical costs.

Nice To Haves

• Familiarity with Data Science Techniques and languages like Python and R programming.

Responsibilities

• 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 develop ad-hoc as well as automated analytical modules related to Risk Adjustment for Medicaid, Marketplace and Medicare/MMP.
• Assist in designing and developing Automated Suspect and Target/Ranking Engine for all lines of business.
• Conduct analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related financial data like risk score, revenue and cost.
• Perform root cause analysis for business data issues and report findings to leadership.
• Design and lead development of tracking system for risk scores for all intervention outcomes and for overall markets and LOB.
• Work in an agile business environment to derive meaningful information from complex organizational data sets through data analysis and mining.
• Collaborate with interdepartmental and intradepartmental stakeholders to establish and deliver business requirements.
• Analyze data sets and trends for anomalies and opportunities using statistical tools and techniques.
• Assist with research and completion of special projects as requested by internal departments or external organizations.
• Act as a subject matter expert on CMS/State regulations related to Risk Adjustment Analytics and provide necessary training.
• Track and manage changes in the Datawarehouse platform and perform upgrades to analytics reporting modules.
• Conduct preliminary and post impact analyses for any logic and source code changes in data analytics and reporting modules.
• Develop training modules for analysts to understand processes and solutions.
• Maintain a team culture that fosters a positive attitude towards challenging projects and accountability.

Benefits

• Competitive benefits and compensation package.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree