Requisition# 20203

Employment Type

Experience

Required Degree

Location

Region

Questions

POSITION SUMMARY

HEDIS Data Analyst supports the Quality Improvement by providing analytical expertise to ALL product lines for HEDIS that directly align with NCQA, CMS and DMHC guidelines. This position will work directly with the Quality Improvement and Risk Adjustment Departments

ESSENTIAL DUTIES AND RESPONSIBILITIES

• The HEDIS Data Analyst is responsible for the coding and maintenance of all file submissions to the QI HEDIS repository, ensuring monthly timely submission and Quality Assurance
• Ensures that generated reports from the QI repository are accurate including performance measurement rates by performing quality assurance audits.
• In addition, this position will be directly responsible for identifying and quantifying key drivers as well as investigating areas for opportunities, effectiveness of initiatives and providing recommendations for improvement.
• The HEDIS Analyst will develop Clinical dashboards to capture data and identify areas of improvement as well as producing report cards including HEDIS, STARS and Risk Adjustment Scores.
• Works with QI, Risk Adjustment and IT departments on activities related to QI including but not limited to software programs, database projects and data transfer with QI and RA repositories.
• Coordinates intradepartmental and interdepartmental activities to assure understanding of the Quality Assessment and Performance Improvement Program and compliance with NCQA, CMS and DMHC.
• Identifies and tracks clinical and operational opportunities and assists stakeholders with program planning and decision-making around the use of data.
• Assists with ROI and outcome reporting.
• Accepts and performs other duties as assigned.

CORE COMPETENCIES

Must possess and consistently demonstrate the following competencies:

• Demonstrates robust analytical and sound decision-making skills
• Basic Understanding of Coding
• Advanced skill level with use of Excel, SQL.
• Exceptional data analysis skills.
• Database Query Skills
• Knowledge of EDI
• Knowledge of Calinx preferred
• Independent worker

QUALIFICATIONS

• Bachelor’s degree or clinical licensure required
• Minimum 2-3 years recent experience as a healthcare analyst

PHYSICAL REQUIREMENTS

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.