Manager, Risk Adjustment / Predictive Analytics
Company: Molina Healthcare
Posted on: September 16, 2022
Job Description Job Summary Manager, Risk Adjustment -
Predictive Analytics is responsible for leading, organizing and
directing Molina's Risk Adjustment Predictive Analytics team.
Provides oversight and support in the design and development of
Suspect, Targeting, and Tracking System to support Molina's
Prospective and Retrospective Interventions. -
- Manage Prospective and Retrospective Intervention Strategy
Analytics along with corresponding tracking of progress and impact
of such interventions.
- Manage the design and development of ad-hoc as well as
automated analytical modules related to Risk Adjustment for
Medicaid, Marketplace and Medicare/MMP.
- Manage the designing and developing of Automated Suspect and
Target/Ranking Engine for all line of businesses.
- Develop 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.
- Manage the design and lead development of tracking system for
risk scores for all intervention outcome and for overall markets
- Provide oversight for team members who 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
- Collaborate 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.
- Provide oversight for team members who 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.
- Manage the team members who track, facilitate, and manage
changes in the Datawarehouse platform and perform transparent
upgrades to analytics reporting modules to ensure no impact to the
- 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. - -
- Maintain a team culture to adopt fast faced agile environment
and foster a positive attitude to take on challenging and time
- Take accountability of tasks and projects to ensure direct
reports are meeting the requirements as assigned. - Job
Qualifications REQUIRED EDUCATION: Bachelor's Degree in Computer
Science, Finance, Math or Economics or equivalent discipline
- 3+ Years of Manager/ Supervisory or Lead experience
- 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
- Familiarity with Data Science Techniques and languages like
Python and R programming would be an added advantage.
- 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 PHYSICAL DEMANDS: Working
environment is generally favorable and lighting and temperature are
adequate. Work is generally performed in an office environment in
which there is only minimal exposure to unpleasant and/or hazardous
working conditions. Must have the ability to sit for long periods.
-Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential function. - To all current
Molina employees: If you are interested in applying for this
position, please apply through the intranet job listing. Molina
Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Keywords: Molina Healthcare, Homestead , Manager, Risk Adjustment / Predictive Analytics, Executive , Homestead, Florida
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