JOB SUMMARY

The Senior Analyst will serve a key role on the RADV (Risk Adjustment Data Validation) team, contributing to the end-to-end data strategy and execution of CMS and internal audit activities. This position is responsible for supporting RADV audit cycles by identifying, synthesizing, and validating source data needed to build chart retrieval chase lists for medical record collection. Success in this role requires a blend of strong technical acumen, business context, and analytical curiosity. While data is primarily accessed through Databricks, not all required elements are neatly organized or centralized. The analyst will be expected to investigate and connect disparate data sources, with the support of experienced team members and cross-functional partners. This is a collaborative role well-suited for individuals who enjoy navigating ambiguity, solving complex problems, and contributing to initiatives that directly support regulatory and clinical compliance.

KNOWLEDGE/SKILLS/ABILITIES

• Support RADV audit execution by identifying appropriate data sources, validating CMS audit samples, and generating chart retrieval chase lists in coordination with internal teams.
• Analyze structured and unstructured data sets using Databricks SQL and other tools to locate and confirm data elements required for audit response.
• Collaborate with internal stakeholders—including IT, Risk Adjustment operations, clinical teams, and retrieval vendors—to ensure accurate data sourcing and alignment with audit requirements.
• Interpret CMS audit specifications and translate them into data logic and operational requirements.
• Document methodology, assumptions, and data sourcing logic to maintain audit traceability and facilitate knowledge sharing.
• Assist in preparing for internal simulations and proactive readiness assessments related to RADV audits.
• Investigate data inconsistencies and assist in performing root cause analysis, offering insight into potential data gaps or operational improvements.
• Work iteratively and adaptively when data is incomplete or spread across multiple systems, using sound judgment to build defensible audit datasets.
• Present findings and progress updates to project leads and stakeholders, contributing to a collaborative, informed audit response process.

REQUIRED EDUCATION

Bachelor’s Degree in Computer Science, Finance, Math or Economics or equivalent discipline

REQUIRED EXPERIENCE

• 3-5 Years of experience with healthcare-related data (claims/encounters, provider, CMS/EDGE response files, etc.
• 3-5 Years of experience with advanced SQL-based analytics (procedures, window functions, dyanamic SQL, ETC.)
• 3-5 years of experience in working with Databricks for analytics and workflows.
• 3-5 Years of experience in health plan Risk Adjustment analytics.
• Core database fundamentals (Primary/Foreign Keys, Relational Databases, Normalization, Transactions, etc.)
• 1-3 years of programming experience in python to support automated data validation / processing at scale (functions and objects)

ABOUT US

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
JOB TYPE Full Time

Please refer the Job description for details