HEDIS Analyst - Health Plan

Location: Philadelphia, PA
Date Posted: 02-01-2018
HEDIS® Program Analyst - Managed Care
Philadelphia, PA
*** This is a Full Time, Direct Hire, Permanent opportunity, supporting HEDIS activities year-round! ***

Your Job Summary:

The HEDIS Program Analyst is an integral part of the team supporting planning and execution on activities related to the collection and analysis of HEDIS data.  The HEDIS Analyst supports corporate, plan-level, and departmental strategies and goals for HEDIS process, and ensures reports are delivered according to technical specifications and deadlines.  HEDIS duties include assisting with managing the HEDIS lifecycle process for multiple plans, oversight of medical record review done by chart reviewers, data accuracy and reporting, and interacting (when needed) with HEDIS auditors for regulatory compliance according to regulations.  

Your Reward: 

This established, national managed care organization is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including, 401(k) with company match, 20 - 35 days of PTO (depending on career band) +9 paid Holidays, tuition reimbursement program, Flex Spending Accounts (FSA) and Healthcare Spending Accounts(HAS).  In addition, they offer very low-cost medical/health insurance and FREE vision, dental, and life insurance. Furthermore, the organization provides Commuter/Travel benefits, Adoption Assistance program, Work-Life Balance Program, Financial Planning Assistant, and a brand new Health Advocate program!

Your Background: 

Bachelor of Science in Nursing, Business, Analytics or related field is required; Master's degree is a plus.
Prefer, but does NOT require, advanced certifications or clinical licensure (i.e. CPHQ, RN or LPN, etc).
At least 3-5 years’ experience in healthcare, preferably with a Managed Care Organization (Health Plan/HMO/MSO/TPA/IPA/etc).
Around 2-4 combined years of prior recent HEDIS experience, including roles such as data collection, over-reading, analysis, etc.
Basic understanding of statistics, data analytics, modeling, reporting methods and data mining methodologies.
Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
Strong analytical mind, with problem solving and investigative skills, an aptitude for accuracy, and attention to detail.
Must be computer literate and knowledgeable in MS Office, E-mail and EMR systems, and multiple additional programs including word processing, and data management.  
At least 1-3 years of SQL and/or SAS experience required.
Possess superior verbal and written communication skills, able to interface with business and medical professionals.
Willing and able to work from a home-office, with occasional (about once per month) travel to offices in Philadelphia.
Your Duties:
  • Provide general support by serving as a subject matter expert for the analysis of data related to the annual HEDIS project, and monitoring progress and accuracy.
  • Ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines.
  • Manage the HEDIS lifecycle process for multiple plans.
  • Assure the accuracy and validity of both source data and results, and interpreting results into recommendations.
  • Assist in preparation for the HEDIS audit; including the HEDIS Roadmap and other documents required by auditors.
  • Develop and maintain HEDIS based report to support Quality Initiatives.
  • Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
  • 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 to conduct data extraction from source systems for validation and analysis.
  • Supports the management and validation of HEDIS data, assures data integrity and reporting.
  • Assist with the management of external vendor performance related to medical record data collections.
  • Accurately assess data, identify opportunities and facilitate cross-departmental prioritization of rate improvement quality work.
  • Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to senior management.
  • Assists with the formal presentations of trending reports throughout HEDIS cycle to keep executive management apprised of current status.
  • Assist in coordinating new enhancements, including system enhancements and report generation, to improve HEDIS scores.

® “HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).”
CareNational Healthcare Services
623.201.8732 (CALL – TEXT – FAX)
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