HEDIS Data Analyst

Job Details

The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reports to help management from other departments do their jobs more effectively. The HEDIS Data Analyst will assist the HEDIS Team with all HEDIS based reporting and analysis. This person will be responsible for compiling, verifying, and analyzing data to assist in the monitoring of HEDIS results. The position will assist with supporting the Quality Management Department with HEDIS performance and regulatory reporting. The analyst will be responsible for verifying data sources and measure results, preparing member level detail, and analyzing results in order to understand the business and propose future program enhancements. The analyst will gain exposure to a broad range of financial, clinical, and analytical issues.

Job Description

Summary The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reports to help management from other departments do their jobs more effectively. The HEDIS Data Analyst will assist the HEDIS Team with all HEDIS based reporting and analysis. This person will be responsible for compiling, verifying, and analyzing data to assist in the monitoring of HEDIS results. The position will assist with supporting the Quality Management Department with HEDIS performance and regulatory reporting. The analyst will be responsible for verifying data sources and measure results, preparing member level detail, and analyzing results in order to understand the business and propose future program enhancements. The analyst will gain exposure to a broad range of financial, clinical, and analytical issues.

Job Duties

• Able to work in a constant state of alertness and safe manner
• Prepare required regulatory reports which shows the progress on the collection, reporting, and analysis of the HEDIS quality measures and non- HEDIS quality measures, including documenting any challenges encountered and how resolution was accomplished. These reports are due semi-annually, annually and once the program has completed.
• Assist with the preparation of monthly data files to load into Quality Spectrum Insight (QSI) HEDIS software.
• Prepare care gap reports for various outreach efforts.
• Assist with DHS-related reports as well as other non HEDIS data requests as needed.
• Support HEDIS team with the submission of the NCQA IDSS, CMS Patient-Level Detail files, and PA Performance Measures.
• Create accurate and meaningful reports for various departments and management using QlikView, Inovalon’s Quality Spectrum Insight-XL (QSI-XL), MS Access, MS Excel and other reporting tools as necessary.
• Be a contributor to the HEDIS team.
• Review detailed claims data in order to verify HEDIS rates, as necessary.
• Use QlikView, SQL, QSI-XL, Excel, or other appropriate tools to obtain, validate and analyze relevant data.
• Maintain and automate reports to support HEDIS.
• Verify and analyze report data and prepare documentation of processes needed for development and improvement of applications.
• Effectively communicate results of analysis.
• Research data issues to determine source of discrepancies.
• Identify, communicate and monitor areas for improvement
• Share knowledge with other team members to improve processes, quality and data integrity.

Minimum Qualifications

• Bachelor’s Degree in actuarial science, mathematics, statistics or other analytical field of study.
• 3 years of data reporting and analysis experience including clinical/healthcare data experience with emphasis on HEDIS reporting in managed care and/or medical quality assurance.
• Strong Working knowledge of SQL or comparable programming language.
• Familiarity with provider coding practices using CPT, ICD-9 and ICD-10 codes, DRGs, and other procedure codes.
• Experience with delivery and reimbursement of medical services in a managed care environment.
• Strong problem-solving, quantitative and analytical skills
• Ability to use computer spreadsheet (Excel) and database (Access and others) tools at advanced level
• QlikView querying and reporting. Dashboard building a plus.
• Experience with data presentation including charts, graphs and other exhibits.
• Ability to communicate effectively both orally and in writing
• Ability to handle multiple responsibilities and changing priorities
• Ability to quickly learn and implement knowledge of new technical processes
• Must pay attention to details
• Excellent organizational skills

Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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