Senior Analyst, Quality Analytics & Performance Improvement

Job Description

Job Summary

The Analyst, Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Assist with research, development, and completion of special performance improvement projects.

 

ESSENTIAL JOB DUTIES:

• Work cross functionally with various departments to capture and document requirements, build reporting solutions, and educate users on how to use reports.
• Assist Quality Data Analytics Leaders in Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions.
• Assist retrospective HEDIS rate tracking and supplemental data impact reporting.
• Develop Medical Record Review project reporting to track progress and team productivity reporting.
• Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates.
• Assist Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting.
• Calculate and track HEDIS rates 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.
• Do root cause analysis for business data issues as assigned by the team lead.
• 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.
• 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.
• Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic 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 oneself as HEDIS subject matter expert to help health plan improve performance on underperforming measures.

 

Job Qualifications

REQUIRED EDUCATION:

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

REQUIRED EXPERIENCE:

• 5+ 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.
• 3+ years of experience with Microsoft Azure, AWS, or Hadoop.
• 3+ Years of experience with predictive modeling in healthcare quality data.
• 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP.
• 3+ Years of experience in working with increasingly complex data problems