Analyst, Health Plan Risk & Quality Reporting (Remote in FL)

Job Overview

Job Summary Provides analyst support for health plan risk and quality reporting activities. Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of initiatives.

Educates users on how to use reports related to risk and quality/Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid, Medicare, Marketplace and Medicare/Medicare-Medicaid Plan (MMP).

Job Description

Assists with research, development, and completion of special quality performance improvement projects including root-cause analysis.

• Builds intervention strategy reporting for the risk and quality interventions and measures gap closure. • Builds ad hoc quality reports as requested to track HEDIS performance and supplemental data monitoring.

• Develops quality assurance (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 including medical claims, pharmacy, lab and HEDIS rates. • Collaborates with the national risk and quality team on testing of pre-production reporting for assigned health plan.

• Calculates and tracks gap closure and intervention outcome reporting for the assigned health plan.

• 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.

Key Responsibilities

• Job Summary Provides analyst support for health plan risk and quality reporting activities.
• Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of initiatives.
• Essential Job Duties • Captures and documents health plan quality reporting requirements, builds custom reports, and educates 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 quality reports as requested to track HEDIS performance and supplemental data monitoring.
• Develops custom health plan reports related to managed care data including medical claims, pharmacy, lab and HEDIS rates.
• Assists with research, development and completion of special quality-related projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
• Represents as a HEDIS subject matter expert, and supports health plan improve performance on underperforming quality measures.

Required Skills and Qualifications

• Required Qualifications • At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience related to HEDIS and/or risk adjustment, and 1 year of experience in a managed care organization, or equivalent combination of relevant education and experience.
• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.
• Experience writing complex SQL queries, functions, procedures and data design.
• Experience with Microsoft Azure, Amazon Web Services (AWS), or Hadoop.
• Effective verbal and written communication skills.
• Preferred Qualifications • Certified Professional in Healthcare Quality (CPHQ).
• If licensed, license must be active and unrestricted in state of practice.

Benefits and Perks

• Molina Healthcare offers a competitive benefits and compensation package.

Work Location and Schedule

This role is listed as Remote USA with location information shown as Remote USA. The employment type is Full Time.

About the Company

Molina Healthcare is the organization connected with this listing. USA Jobs Today displays this opportunity for job discovery only, so applicants should verify company details, application instructions, and eligibility on the official employer website.