[Hiring] HEDIS Quality Improvement Analyst @Medical Mutual

Role Description

This role is fully remote, and we are targeting candidates who reside in Ohio.

HEDIS Quality Improvement Analyst I

Supports corporate and departmental strategies and goals in alignment with regulatory specifications for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including:

• HEDIS audit submission
• Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Health Outcomes Survey (HOS)

Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members' health outcomes.

Responsibilities:

• Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap, including data documentation, compilation, reconciliation, and research.
• Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures.
• Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
• Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.
• Collaboratively reviews mapping documentation for annual HEDIS Specification update application and coordinates implementation.
• Supports interdepartmental and vendor project planning coordination and facilitation.
• Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records.
• Works closely with HEDIS vendor support to ensure data integrity and chart collection.
• Produces routine HEDIS reporting to support clinical Quality initiatives to improve member health.
• Participates in required trainings and performs other duties as assigned.

HEDIS Quality Improvement Analyst II

Supports corporate and departmental strategies and goals in alignment with regulatory specifications for the annual HEDIS lifecycle processes.

Responsibilities:

• Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap, including data documentation, compilation, reconciliation, and research.
• Works directly with external HEDIS/NCQA auditor to resolve any items on Issue Log.
• Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures.
• Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
• Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.
• Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.
• Supports interdepartmental and vendor project planning coordination and facilitation.
• Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records.
• Produces routine to moderately complex HEDIS reporting to support clinical Quality initiatives to improve member health.
• Orients and trains more junior-level Analysts.
• Participates in required trainings and performs other duties as assigned.

HEDIS Quality Improvement Analyst III

Produces reporting and analyses to identify actionable opportunities for quality improvement across all lines of business.

Responsibilities:

• Provides analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers.
• Produces in-depth, customized trend reporting across multiple systems and delivers recommendations to improve quality metrics.
• Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and/or providers.
• Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures.
• Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
• Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.
• Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation.
• Supports interdepartmental and vendor project planning coordination and facilitation.
• Orients, trains, and assists more junior-level Analysts.
• Participates in required training and performs other duties as assigned.

Sr HEDIS Quality Improvement Analyst

Develops reporting and analyses to identify actionable opportunities for quality improvement across all lines of business.

Responsibilities:

• Leads analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers.
• Leads production of in-depth, customized trend reporting across multiple systems and delivers recommendations to improve quality metrics.
• Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and/or providers.
• Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures.
• Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
• Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.
• Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation.
• Orients, assists, trains, mentors, coaches, and reviews work of more junior-level Analysts.
• Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation.
• Supports interdepartmental and vendor project planning coordination and facilitation.
• Participates in required training and performs other duties as assigned.

Qualifications

• Bachelor’s Degree in health care administration, public health, or a related field.
• 2-5 years of experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience.
• Master’s degree (MBA, MPH, or MHA) preferred for Sr HEDIS Quality Improvement Analyst.

Requirements

• Basic to advanced proficiency in database reporting (SQL) and analytics programming languages (SAS).
• Foundational to advanced knowledge of health insurance industry and health plan operations.
• Ability to draft analytical assessments and summarize content in simplified language.
• Ability to identify opportunities and propose solutions.
• Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.

Benefits

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life, and disability insurance.
• Access to an Employee Assistance Program.
• Company holidays and up to 16 PTO days during the first year of employment.
• Parental leave for eligible employees after 120 days of service.
• Career development programs and classes.
• Tuition reimbursement up to $5,250 per year.
• Diverse, inclusive, and welcoming culture with Business Resource Groups.