Job description

JOB TITLE: HEDIS & Quality Analyst

LOCATION: REMOTE

JOB TYPE: Direct Hire - W2 - Onsite

DESCRIPTION

Establishes business rules for accurate use of HEDIS (HealthCare Effectiveness Data and Information Set) reporting data fields. Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures.

Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues and facilitates resolution of such issues.

Supports identification of training opportunities and assist in mentoring and training associates in regards to HEDIS. Position interacts with associates at all levels in the organization, external clients and vendors

• Manage the HEDIS lifecycle process for multiple plans.
• Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations.
• Develops and implements data-driven solutions to meet business requirements by producing analytics, reports, and data sets.
• Assist as necessary in the review of medical records.
• In collaboration with the HEDIS manager to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple LOBs.
• Assist in preparation for the HEDIS audit.
• Develop and maintain HEDIS based report to support Quality Initiatives.
• Represent HEDIS team in collaboration with internal departments for HEDIS improvement.
• Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
• Assists as necessary in the HEDIS Road Map and all other documents required by auditors.
• Able to assimilate into team within minimum amount of assistance
• Assures the ongoing high-performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers
• Experience and ability to utilize a certified HEDIS software
• Experience reviewing medical records is a plus

REQUIREMENTS

• Bachelor’s Degree required with a concentration in health care related field;
• Minimum 2 years HEDIS experience required.
• Requires 4-6 years of experience in healthcare and/or managed care
• Healthcare payer experience preferred
• SQL experience required.
• Tableau / Power BI experience preferred
• Experience utilizing a certified HEDIS software

Job Type: Full-time

Salary: From $69,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Experience:

• HEDIS: 4 years (Required)
• Healthcare management: 4 years (Preferred)
• Inovalon QSI-XL: 2 years (Preferred)
• Tableau: 4 years (Preferred)
• SSIS: 4 years (Required)
• Power BI: 4 years (Preferred)

Work Location: Remote

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