Sr Risk Adjustment Management Analyst (4213BR) Long Beach, California

Job Summary

Responsible and accountable for supporting the Risk Adjustment Management Program (RAMP) Department by collecting and analyzing healthcare related data by performing data management and quality improvement studies on that data and producing the resulting reports.

Essential Functions

• Assist in the design and the execution of risk adjustment management activities. The analyst assures the success of risk adjustment projects by performing statistical data analysis and implementing projects in accordance with research design. This individual will be a liaison between the Claims/Encounter Data team, Medicare Finance, and the Revenue Analytics team and will perform research functions by collaborating with other members of the RAMP team, creating reports, and formatting and coordinating intervention studies.
• Implement and coordinate monthly HCC provider/physician group reports by extracting and preparing member data files for vendor use; retrieving and loading vendor prepared data files; generating reports; distributing report products to providers and members.
• Assure the success of projects by performing data analysis using SQL programming and other analytical tools as well as processing and managing member and provider communications as appropriate to each project. Projects will include, but not limited to, risk adjustment management, population quality improvement, health promotion activities initiated within RAMP, and outcome research studies.
• Maintain professional and technical knowledge by conducting research and by attending educational and technological workshops.
 
State Plan / Department Specific Duties and Responsibilities
• Monitor Risk Scores at various levels of detail (e.g. by state, by product, by demographic segmentations)
• Resolve and track escalated issues.
• Participate as a team player by demonstrating support to peers, management and the department’s goals.

Knowledge/Skills/Abilities

• Computer literate.
• Excellent analytical and problem-solving skills.
• Ability to effectively prepare various financial analysis and data mining activities.
• Excellent verbal and written communication skills.
• Ability to effectively interface with staff, clinicians and management.
• Excellent verbal and written communication skills
• Ability to abide by Molina’s policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers



Required Education: 
Bachelor’s degree in health care related area, preferably with emphasize in quantitative data analysis, statistics and/or bio-statistics and/or equivalent combination of relevant education and experience. 
   
Required Experience:  
5 – 7 years of experience in a healthcare setting and in analytics and data analysis.
 
Required Licensure/Certification:
N/A    
 
Preferred Education:
MBA or MHA
 
Preferred Experience:
Background in supporting risk adjustment activities and clinical informatics.
Health Care data processing experience including claims, encounters, diagnosis & procedures code, and pharmacy data   
 
Preferred Licensure/Certification:
N/A   
 



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

To apply, please click here