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HEDIS Analyst Sr - remote
Location: Remote, United States
Primary Job Function: Medical Management
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Responsible for the support, maintenance, and developmental strategies for HEDIS throughout the AmeriHealth Caritas Family of Companies. Ensures the maximum level of data accuracy, integrity, consistency, and completeness in the various internal and external data sources used for end-user reporting purposes (e.g., Oracle data warehouses, various supplemental data sources). Identifies data-related issues, and conducts root cause analyses; facilitates resolution of known issues by working directly with end-users and IT staff. Works closely with the Quality Team and Medical Record Review vendors as needed to ensure that the medical charts meet the standards as outlined by HEDIS specifications (understanding provider chase logic). Assist as needed in the creation and support of the Roadmap, HEDIS audit, and various HEDIS reports including QA. Establishes business rules for accurate use of reporting data fields. Identifies new and maintains existing sources of data to ensure the availability of information for reporting purposes. Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all LOBs. Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues, and facilitates resolution of such issues. Supports identification of training opportunities and assist in mentoring and training associates in regards to the HEDIS process and timeline. Position interacts with associates at all levels in the organization, external clients and vendors.
Essential Functions include but not limited:
Manage the HEDIS lifecycle process for multiple plans.
Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations.
Develops and implements data-driven solutions to meet business requirements by producing analytics, reports, and data sets.
Assist as necessary in the review of medical records.
In collaboration with the HEDIS manager to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple LOBs.
Assist in preparation for the HEDIS audit.
Develop and maintain HEDIS based report to support Quality Initiatives.
Represent HEDIS team in collaboration with internal departments for HEDIS improvement.
Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
Assists as necessary in the HEDIS Road Map and all other documents required by auditors.
Able to assimilate into team within minimum amount of assistance
Assures the ongoing high performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers
Experience and ability to utilize a certified HEDIS software
Experience reviewing medical records is a plus
Bachelor’s Degree required with a concentration in health care related field; Master’s Degree preferred.
Minimum 2 years HEDIS experience required, 4 years preferred.
Minimum 5 years of work experience in healthcare and/or managed care.
SQL experience required. Tableau / Power BI experience preferred
Experience utilizing a certified HEDIS software
EOE Minorities/Females/Protected Veterans/Disabled
AmeriHealth Caritas provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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