Job Description Job Summary The Sr Analyst, Risk Adjustment - Predictive Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs and develops Suspect, Targeting, and Tracking System to support Molina's Prospective and Retrospective Interventions. Assist with research, development, and completion of special projects. Knowledge/Skills/Abilities - Assist Risk Adjustment Data Analytics Leaders in Prospective and Retrospective Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions. - Development and QA of ad-hoc as well as automated analytical as well as Reporting modules related to Risk Adjustment for Medicaid, Marketplace and Medicare/MMP. - Assist Risk Adjustment Data Analytics Leaders in designing and developing Automated Suspect and Target/Ranking Engine for all line of businesses. - Analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and related financial data like risk score, revenue and cost. - Calculate and track risk scores for all intervention outcome and for overall markets and LOB. - 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. - Conduct root cause analysis for business data issues as assigned by the team lead. - 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. - Assist with 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. - Track, Facilitate and Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic 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 oneself as subject matter expertise by following CMS/State regulations related to Risk adjustment Analytics. Job Qualifications Required Education Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline Required Experience - 3-5 Years of experience in working with data mapping, scrubbing, scrapping and cleaning of data. - 3-5 Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design - 3-5 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. - 3-5 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. - 3-5 Years of experience in Prospective/Retrospective/Audit targeting Analytics and Reporting. - 3-5 Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics. - 3-5 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.

• Conduct detailed and accurate medical record reviews using ICD-10-CM Official Guidelines, AHA Coding Clinic, and internal IRIS Coding Guidelines. • Complete Pre-Encounter Preparation (PEP) and concurrent coding workflows with high accuracy and efficiency. • Monitor analytics dashboards to identify documentation and coding gaps, trends, and improvement opportunities. • Ensure compliance with CMS risk adjustment guidelines, HCC frameworks, and RADV audit standards. • Maintain a coding accuracy score of 95% or higher through consistent quality and adherence to guidelines. • Serve as the primary contact for assigned PACE clients, providing ongoing risk adjustment guidance and support. • Collaborate with providers to improve documentation quality, accuracy, and completeness. • Deliver structured feedback loops, one-on-one coaching, and ongoing documentation improvement strategies. • Conduct monthly metric reviews with clients to assess performance, identify gaps, and recommend improvement plans. • Lead onsite training sessions during onboarding, go-live, and optimization phases—including Risk Adjustment 101, PEP training, and provider coaching. • Host virtual training sessions focused on provider workflows, documentation excellence, analytics dashboards, and coding refreshers. • Conduct biweekly office hours, ensuring sessions are recorded and accessible for asynchronous learning. • Tailor training content to diverse clinical roles and workflows, demonstrating strong presentation and facilitation skills. • Develop and execute customized onboarding plans for each client. • Coordinate risk adjustment deliverables and timelines across platform teams and service lines. • Support workflow design and optimization by recommending enhancements based on client feedback, quality reviews, and data insights. • Contribute to system upgrade recommendations and configuration improvements that strengthen documentation and coding workflows. • Support accurate risk adjustment data submissions to CMS and other regulatory bodies. • Participate in internal quality reviews, audits, and coding accuracy checks. • Maintain detailed documentation of coding decisions, audit notes, and workflow recommendations.

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: - Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, - Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and - Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health. Position Summary The Audit Analyst supports the lifecycle of regulatory and client audits from intake through completion. This role coordinates deliverables, organizes documentation, maintains audit repositories, and ensures timely, consistent responses. The Analyst plays a critical role in supporting organizational readiness, tracking progress, and ensuring quality standards are upheld. Position Responsibilities: - Monitor audit intake channels and route audit requests appropriately. - Track deliverables, timelines, and cross-functional dependencies. - Support submission of readiness through formatting, document quality checks, and version control. - Maintain audit artifacts, documentation, and repository organization. - Track corrective action tasks and follow-ups. - Support reporting and communication with internal stakeholders. - Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. Required Qualifications: - Bachelor’s degree or equivalent experience. - 1–3 years of experience in compliance, operations, documentation management, or related fields. - Strong organizational skills and attention to detail. - Ability to coordinate across multiple teams and timelines. Salary Range $80,000—$110,000 USD All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

• Maintain accurate PG‑related data and documentation supporting reporting and visibility. • Track PG commitments, exceptions, and approval requirements. • Support review of contract redlines or PG‑related issues under the direction of senior team members. • Assist with Finance-driven processes related to forecasting or accrual considerations. • Maintain governance documentation, workflows, and tracking of PG activities. • Support identification of trends, risks, or process improvement opportunities.