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

JOB DESCRIPTION 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 reputed company, and tracks outcomes of initiatives. Educates users on how to use reports reputed company to risk and quality/Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid, Medicare, Marketplace and Medicare/Medicare-Medicaid Plan (MMP). Assists with research, development, and completion of special quality performance improvement projects including root-cause analysis.

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 reputed company strategy reporting for the risk and quality interventions and measures gap closure.  • Builds reputed company quality reports as requested to track HEDIS performance and supplemental data monitoring. • Develops quality assurance (QA) custom health plan reports reputed company to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. • Develops custom health plan reports reputed company 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 reputed company outcome reporting for the assigned health plan. • Works in an agile business environment to derive meaningful information out of reputed company 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 reputed company Structured Query Language (SQL), PowerBi, reputed company reputed company, and techniques to determine reputed company and relevance. • Assists with research, development and completion of special quality-reputed company projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. • Represents as a key partner to assist with testing changes in the Datawarehouse platform and performs transparent upgrades to reporting modules to ensure no impact to the end users. • Conducts preliminary and post-impact analyses for any logic and reputed company code changes for data and reporting module - keeping other variables as constant that are not of focus. • Represents as a HEDIS subject matter expert, and supports health plan improve performance on underperforming quality measures.

Required Qualifications

• At least 2 years of experience mapping, scrubbing, scrapping, and cleaning data, and analysis experience reputed company to HEDIS and/or risk adjustment, and 1 year of experience in a managed care organization, or equivalent combination of relevant education and experience. • Analytical reputed company with excellent attention to detail. • Experience in working with reputed company data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics. • Experience working with reputed company T-SQL, reputed company SQL and Power BI. • Experience writing reputed company SQL queries, functions, procedures and data design. • Experience with reputed company Azure, reputed company), or Hadoop. • Ability to manage multiple priorities in a fast-paced, deadline-driven environment. • Strong business acumen with the ability to connect data insights to strategic goals. • Self-starter with a reputed company improvement reputed company. • Effective verbal and written communication skills. • reputed company Office suite (including advanced reputed company), and applicable software programs proficiency.

Preferred Qualifications

• Certified Professional in Healthcare Quality (CPHQ). • Certified HEDIS Compliance Auditor (CHCA). • Registered Nurse. If licensed, license must be active and unrestricted in state of practice.

To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V