The HEDIS Expert Analyst is responsible for project coordination and contribution to the annual HEDIS audit and Medical Record Review (MRR) project functions including, but not limited to, communicating between internal and external teams, managing project resources, tracking deliverables and issues, monitoring measure rates and contributing to reporting for clients and internal leadership.
Preparing and managing detailed project timelines and diligently track deliverables to clients and auditors to meet strict deadlines.
Ensures complete, accurate and timely submission of audit deliverables per NCQA, auditor and internal deadlines.
Collaborates with Subject Matter Experts to develop and/or complete documents including the NCQA HEDIS ROADMAP.
Participates in client onsite visits with the NCQA certified auditor.
Participates in medical record audits for supplemental data and MRR.
Acts as a key contributor during the MRR project by strategically managing employee resources, monitoring hybrid measure rate performance, overseeing vendor performance and appropriately handling any issues that may arise.
Develop ideas for overall process improvement and implementation.
Assist with developing and deploying annual inter-rater reliability testing and training.
Develops documentation, reports and presentations for all levels within the organization including executive leadership.
Coordinates projects and analysis for management and team.
Possesses and maintains a comprehensive understanding and knowledge of business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and research principles/methodologies.
Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
Communicates results of analysis to management and clients via reports/presentations and assist management in implementing programs that provide solutions.
Recommends and implements solutions to identified problems/root cause of issues.
Represents and participates in group or committee discussions.
Provides expertise and guidance to unit and corporate staff as required.
Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
Completes ad hoc data requests as assigned. Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics or a related field. Master's degree preferred. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Strong communication skills are required to understand, interpret, and communicate ideas.
Strong knowledge of HEDIS technical specifications and hybrid measures (particularly for Medicare Advantage reporting)
Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
Strong analytical, organizational, planning, and problem-solving skills.
Ability to effectively interface with employees at all levels.
Experience executing in a fast-paced environment with tight deadlines.
Administer and adhere to corporate and departmental policies, practices and procedures.
Strong project management and leadership skills
Other related skills and/or abilities may be required to perform this job.
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued, and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.