The organization is looking to solve the problem of improving HEDIS measures and ratings by gathering and documenting HEDIS data requirements, performing integrated testing for data quality assurance, and developing reports to support decision making and business processes.
Requirements
- Advanced experience with SQL
- Microsoft Office, Visio, Microsoft Project and Microsoft Visual Studio skills
- Ability to analyze large data sets and perform data profiling
- Experience working with healthcare data
- Experience using a certified HEDIS engine
- Knowledge of data analysis on databases/data sets
- Experience with insurance or healthcare industries is preferred
Responsibilities
- Perform activities, processes, and procedures to achieve improvement in HEDIS measures
- Formulate and ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
- Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to senior management
- Manage all clinical quality metrics and HEDIS processes and results
- Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
- Perform data acquisition, analysis, evaluation, and analytics via advanced SQL queries and stored procedures, MicroStrategy, and other data management tools
- Design solutions using BI concepts including dynamic and parameter driven reporting, dashboards, data visualization, and alerts
Other
- Bachelor’s degree from an accredited university in human services, statistics, mathematics, computer science, business administration or related field
- Three (3) years of experience in a Data or Business Analyst position with direct involvement in Healthcare HEDIS analytics and data
- Communication skills
- Excellent written communication skills, including technical writing and document design principles
- Ability to work independently and in a team setting
