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Manager, Risk Adjustment / Predictive Analytics

Company: Molina Healthcare
Location: Chagrin Falls
Posted on: September 24, 2022

Job Description:

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. - Knowledge/Skills/Abilities

  • 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 and LOB.
  • 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 analysis.
  • 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 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 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 sensitive projects.
  • 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 REQUIRED EXPERIENCE:
    • 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 and SSRS.
    • 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. #PJCorp

Keywords: Molina Healthcare, Cleveland , Manager, Risk Adjustment / Predictive Analytics, Executive , Chagrin Falls, Ohio

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