Supports corporate and departmental Strategies and goals for the annual HEDIS submission process. Effectively applies business knowledge and technical expertise to support the business initiatives to report clinical quality of care received by members. Works closely with the Quality team to develop year round strategies to improve quality of care received by members, members' health outcomes.
Responsibilities include, but are not limited to:
Education and Experience:
- Successfully completing the HEDIS submission lifecycle for multiple submissions
- Assuring the accuracy and validity of source data and results and ensuring compliance with HEDIS technical specifications, policies and operating procedures
- Collaborating with Lead and Senior HEDIS Analysts and Quality Improvement Analytics Manager to develop and monitor annual HEDIS project plans and assist with preparations for the annual HEDIS audit, including development of the HEDIS Road Map.
- Establishing business rules for accurate use of reporting data fields
- Identifying new and maintaining existing data sources to ensure the availability of information for HEDIS submission and reporting purposes
- Ensuring all data sent to the HEDIS software vendor are accurate and are submitted consistent HEDIS reporting timelines.
- Identifying data-related issues, conducting root cause analyses, and facilitating resolution of known issues by working directly with the end-users of data and IT staff.
BA/BS in Healthcare Administration, Public Health or a health care related field
Minimum of 2 years of HEDIS-specific knowledge and submission experience.
- Experience using certified HEDIS software, specifically Inovalon
- Demonstrated experience in data extraction (SQL) and analytics programming languages (SAS)
- Ability to perform beginner to intermediate queries and retrieve and integrate data from multiple tables and/or sources
- Demonstrated success with analyzing clinical, claims, pharmacy and encounter data
- Foundational knowledge and experience with the health insurance industry, and particularly with clinical quality measurement.
- Demonstrated effective and long term success with communicating in writing, verbally and with delivering presentations
- Successful project management expertise and experience, a well-developed business sense, the ability to perform in a fast paced environment, and comfort interacting with internal and external senior leaders are critical to success in the role.
- Need to be from Health Insurance side/Payer/Health plan
- HEDIS submission full life cycle experience – a minimum of 2 lifecycles – Prefer 2 – 4 years
- Need to have submitted docs at the end of the cycle to NCQA
- Need to have experience with SAS, SQL and Inovalon SW