Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision making capability. This includes developing or changing workflows and implementing process improvements to enhance organizational products, programs and service to our customers.
Identify and analyze operational data and develop insights in support of business objectives.
Develop and improve work flows and business processes within defined areas to improve customer service, decrease operational costs and improve overall quality.
Identify and/or analyze business problems and develop recommendations for solutions to problems.
Lead the development and implementation of projects and/or teams in order to produce desired results.
Document and communicate project concepts, milestones and results.
Recommend and assist with implementing standard policies and procedures.
Ensure that corporate compliance is communicated, implemented and monitored on an ongoing basis.
Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.
Provide support to internal departments and external entities by answering questions, supplying information and training.
Create and present reports and presentations to display operational data and proposed business changes.
Department Summary / Preferences:
Retrieve data and conduct data-driven analytics utilizing various analytical tools, software, and techniques
Collaborate with leadership and internal teams to make recommendations on HEDIS initiatives and improvement of business operations or processes
Prepare written analysis and summarize results using data visualizations/graphical representations and professional formatting
Present analyses, findings, and recommendations to a broader audience including executive level leaders
Demonstrate substantial depth of knowledge and experience in healthcare domains – claims, provider, encounters, member, pharmacy, lab, clinical etc.
Conduct research and analysis to identify areas of opportunity, issues/risks, or best practices concerning trends associated with HEDIS performance
Perform activities, methods, 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
Assist in clinical quality metrics and HEDIS processes and results
Ensure compliance for all quality audits and maintain all data and process controls
Stay abreast of Stars domains trends and specifications (e.g. HEDIS®, Pharmacy, Survey, Operations)
Research questions raised by management and conduct ad hoc analysis regarding data, trends, and anecdotal evidence
Conduct quality validation on analytical results and provide recommendations on completed analysis
Maintain a high level of competency in statistical and analytical principles, tools, and techniques
Assist in developing new procedures, training, initiatives pertaining to data analysis and analytic development
Partner with other internal areas to share knowledge and research findings
Bachelor's Degree in a related field is preferred.
Four (4) years of experience in a related field is required.
Excellent analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.
Organizational skills and ability to prioritize; must be able to lead multiple activities with varying timelines.
Excellent verbal, written communication and interpersonal skills.
Ability to lead and contribute to business unit and/or corporate projects.
Proficient in Microsoft Office Suites.
Ability to develop and maintain effective working relationships.
Department Required Qualifications:
Bachelor's Degree or higher, majoring in Epidemiology, Public Health, or a Clinically related field
5+ years of data analysis experience within the healthcare industry
2+ years experience with HEDIS and CMS Stars Rating System & Specifications
3+ years of experience with relational databases (SQL Server, Oracle, Access, etc.)
3+ years of complex SQL script writing experience
Experience working with Healthcare claims, lab, pharmacy, provider, and behavioral health data
Experience with administrative data sources including standard coding schemes, HCFA 1500 and UB92 formats
Strong analytical skills with the ability to collect, organize, analyze, and communicate insights
Ability to present findings to leadership and external customers
Experience working with large data sets and data visualization tools
Proficiency in Microsoft office suite including Word, Excel, Outlook, and PowerPoint
Ability to adapt quickly to a fast-paced changing environment
Must be able to work effectively and efficiently with internal teams as well as individually
Excellent written and verbal communication skills
2+ years working with analytical software such as SAS or Tableau
Knowledge of epidemiological study design
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.