Summary of Position:
Lead the implementation of the quality department digital HEDIS strategy under the quality measurement analytics team. Lead efforts to continually improve data capabilities and quality of department analysis and reporting. Develop and implement automation of manual reporting and analysis of business implications and trends. Develop, automate, and manage the intake, use and data governance of clinical and supplemental data sources to support all HEDIS/QARR/Star metrics. Identify areas of opportunity and new data sources to support quality metrics. Work closely with quality department, IT, NCQA certified HEDIS vendor and auditors to ensure readiness for digital quality. Prepare and present analytical dashboards and data to key stakeholders to support strategic decision making.
Principal Accountabilities:
Develop, implement, and manage reporting and reconciliation workflows and document processes.
Lead medical trend studies as they pertain to quality initiatives.
Identify data improvement opportunities through review of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues.
Collaborate with IT and others to plan and execute digital readiness, including readiness for FHIR.Engage with vendors, providers, and others to identify new sources of clinical data ingestion (e.g. data aggregators, EHRs, HIEs, etc).Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
Lead the development of complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
Develop and maintain automated quality dashboards and measure profiles utilizing data visualization tools.
Provide analytical and technical guidance for design, development and maintenance of quality improvement and wellness initiatives. Build self-service reports to be used by the quality department.
Identify and analyze business problems related to quality experience of member, particularly related to how members receive care and other factors influencing the STARS rating.
Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
Collaborate with internal quality management teams to assist on quality improvement initiatives.
Qualifications:- Bachelor’s Degree in analytical/quantitative field including healthcare management, finance, business, mathematics, engineering, applied stats/economics, or any other related fields
- Master’s Degree preferred5 – 8+ years of relevant, professional work experience (Required)5+ years of experience in managed care/healthcare analytics (Required)
- Advanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources (Required)
- Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) (Required)
- Advanced experience with relational database applications (such as SAS, R, SQL, or others). (Required)
- Experience with improving and automating processes using programming languages/software (Python, VBA, R, SAS, C++, or others) (Required)
- Experience with and proficient in statistical software/programs (such as SAS, R, Stata, Minitab or others) (Preferred)
- Experience with and proficient in data visualization tools (such as Power BI, Tableau) (Required)
- Strong communication skills (verbal, written, presentation, interpersonal) (Required)
- Demonstrated self-starter with ability to develop projects end to end independently (Required)
