Lead Analyst, National Risk Adjustment Predictive Analytics (Remote)

Provides lead level analyst support for Molina enterprise risk adjustment predictive analytics activities.

Designs and develops suspect, targeting, and tracking system to support Molina’s prospective and retrospective interventions.

• Assists risk adjustment data analytics leaders in prospective and retrospective intervention strategy analytics, and corresponding tracking of progress and impact of interventions.
• Designs and leads development of tracking system for risk scores for all intervention outcome and for overall markets and lines of business.
• Develops quality assurance (QA) ad-hoc and automated reporting modules related to risk adjustment for Medicaid, Marketplace and Medicare/Medicare-Medicaid Plan (MMP) lines of business.
• Assists risk adjustment data analytics leaders in developing automated suspect and target/ranking engine for all lines of businesses.
• Facilitates analysis and reporting related to managed care data including claims, pharmacy, lab and related financial data (risk score/revenue/cost).
• Calculates and tracks risk scores for all intervention outcomes for all markets/lines of business.
• Works in an agile business environment; derives meaningful information out of complex/large organizational data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis.
• Collaborates with interdepartmental stakeholders and leaders to establish/deliver/explain the business requirement and data/data points, and facilitates escalation as needed.
• Conducts root-cause analysis for business data issues.
• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities using statistical tools and techniques to determine significance and relevance; utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance; provides executive summary of findings to requestors.
• Assists 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.
• Adheres to Centers for Medicare and Medicaid Services (CMS)/state regulations related to risk adjustment analytics, and provides training as required.