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Job Description

JOB SUMMARY:

The CDA Analyst supports enterprise risk adjustment and quality initiatives by collecting, validating, and analyzing clinical and claims data. This role develops reporting solutions that improve clinical data capture, support RADV/CDA activities, and assist HEDIS and quality teams with audit readiness, rate tracking, and intervention monitoring. The analyst transforms complex datasets into actionable insights that guide operational decisions and performance improvement across the organization.

ESSENTIAL JOB DUTIES:

• Collaborates with cross-functional teams to define reporting requirements for key annual Quality deliverables—including RADV/CDA, HEDIS reporting, medical record review (MRR) tracking, supplemental data processing, and intervention performance reporting—and develops accurate reporting solutions while training users on report functionality.

• Supports quality analytics leadership with predictive modeling and trend analysis to identify performance improvement opportunities, guide interventions, and measure their impact.

• Assists with retrospective quality metric tracking, data reconciliation, and analysis of supplemental and encounter data that influence quality outcomes.

• Develops reporting for medical record retrieval and review activities, tracking retrieval progress, documentation accuracy, provider responsiveness, and team productivity.

• Creates quality assurance reporting and automated analytic dashboards for Medicaid, Marketplace, Medicare, and MMP programs to ensure data completeness, accuracy, and regulatory alignment.

• Analyzes claims, encounter, supplemental, pharmacy, and lab data to assess data integrity, monitor key performance indicators, and identify opportunities for quality improvement.

• Supports deep-dive reviews of clinical documentation and coding to strengthen audit readiness, improve data accuracy, and reduce error rates.

• Calculates, validates, and monitors quality measure performance across interventions and lines of business, ensuring alignment with CMS, state, and marketplace requirements.

• Performs data mining, validation, scrubbing, and root cause analysis on large datasets to identify anomalies, data gaps, and process issues affecting quality outcomes.

• Conducts statistical trend analysis to identify anomalies and forecast impacts on utilization, quality performance, and financial outcomes.

• Supports special projects and quality initiatives for internal stakeholders or in response to regulatory agencies, auditors, or external partners.

Job Qualifications

REQUIRED EDUCATION:

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

REQUIRED EXPERIENCE:

• 3+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data.

• 3+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design

• 3+ 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.

• Familiarity with Microsoft Azure, AWS or Hadoop.

• 1-3 Years of experience with predictive modeling in healthcare quality data.

• 1-3 Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP.

• 1-3 Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.

• 1-3 Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan 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.

Pay Range: $49,430.25 - $107,098.87 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.