[Hiring] HEDIS Data Quality Integrity Analyst @Horizon Blue Cross Blue Shield of New Jersey

Role Description

The role is a technical lead that requires deep knowledge, skills, and experience in designing and carrying out quality analytics. The incumbent for this position will design and implement a structured approach to data quality, ensuring our HEDIS data accurately reflects the health status of our members. The position is a key team member collaborating in a multi-disciplinary business environment with colleagues across the enterprise to lead quality performance analytics, development, and reporting that deliver actionable insights. As a subject matter expert, the role collects business requirements as per State, CMS, and NCQA specifications, translates business requirements into analytics design, defines data & analytics specifications, manipulates and analyzes large healthcare data from various data sources, and interprets the findings to inform opportunities and solutions that improve clinical quality and increase cost efficiency and health care affordability. This position requires advanced data analytic programming and coding skills with robust knowledge and understanding of the healthcare business and data.

What You'll Do

• Functions as the implementation lead for projects designed to improve HEDIS, Stars, accreditation and State performance.
• Functions as the vendor relationship owner (VRO) to vendors utilized intended to improve quality performance.
• Builds robust quality assurance criteria and processes to ensure regulatory reporting data is complete and accurate.
• Acts as the analytic liaison for complex clinical analytics projects involving multiple data resources and teams to inform business decisions in clinical, network, and value-based performance models.
• Understands the strategic direction of the organization and the analytic and reporting requirements to meet departmental needs.
• Translates business questions and needs into analytics technical requirements including data analytics design, clinical and data.
• Creates integrated analytic datasets and summarizes findings to inform business opportunities and address business questions.
• Provides insight and guidance into analytic findings (including root causes and contributing factors – both actionable and not) through clear, professional, succinct written and oral summaries, tables, charts, reports, or presentations.
• Navigates across multiple analytical and business units to socialize analytics design, results and interpretation, including making recommendations on how to use the results to inform business decisions.
• Documents methods, specifications and findings clearly.
• Collaborates with team members to document work appropriately, including SAS coding comments and use of analytic plan/timeline where needed for analytic projects.
• Presents analytics findings to internal leadership teams to inform actionable opportunities and solutions.
• Provides technical trainings (analytics design, data, programming, QA, statistics, documentation, etc.) to junior analysts.

Qualifications

• High School Diploma/GED required.
• Bachelor degree in Math, Statistics, Data Science, or Public Health preferred or relevant experience in lieu of degree.
• Requires a minimum of 5 years of experience in data analytics, HEDIS, SAS or related field.
• Requires a minimum of 5 years of experience performing analysis on healthcare data, HEDIS data or relational health care databases with significant experience analyzing medical, pharmacy and behavioral data.

Requirements

• Requires extensive knowledge of US healthcare industry, health plan business, claims data, clinical data, and coding practices.
• Prefers knowledge and working experience of visualization and BI tools (e.g., Tableau) with preference given to Tableau experience.
• Strongly Prefers SAS, SQL and Python experience.
• Requires proficiency with MS Excel for data analysis and reporting.
• Requires solid organizational skills and attention to details.
• Requires strong ability to work in a fast-paced team-oriented environment and strong ability to manage competing priorities.
• Must be highly motivated and able to work independently.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement