Molina Healthcare · 5 hours ago
Lead, Risk Adj-Pred Analytics - Python Scripting/SQL/Databricks - Remote
Arizona, United States
Full-time
Remote
Senior Level
$80K/yr - $188K/yr
6+ years exp
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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 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.
Qualification
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Required
Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline.
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.
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.
Preferred
Familiarity with Data Science Techniques and languages like Python and R programming would be an added advantage.
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10,001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (33)
2022 (36)
2021 (33)
2020 (60)
Funding
Current Stage
Public CompanyTotal Funding
$1.5B2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
2014-09-09Post Ipo Equity· $3.11M
Leadership Team
Dave Reynolds
Executive Vice President, Regional Health Plans
Debbie Simkins
Vice President, Office of the CIO
Recent News
2024-11-13
Fierce Healthcare
2024-11-07
Company data provided by crunchbase
