The Healthcare Data Analyst 3 – HEDIS provides advanced HEDIS reporting coordination and analytical support for the HEDIS reporting process and other QI initiatives within the health plan. This position is mainly responsible for analytic functions described below, but is also responsible for back-up support for the Healthcare Analyst 2 – HEDIS and the Quality and Performance Improvement Team in the production of HEDIS rates and all associated deliverables.
Essential Job Duties:
- Defines and develops analytical methodologies and procedures to provide quantitative solutions for QI initiatives and their implementations and delivery of automated solutions, by querying, collecting, analyzing, summarizing information & trends.
Coordinates HEDIS and QI related projects and customers' expectations by holding primary responsibilities for performing and developing Quality Improvement measures (HEDIS type measures). Exercises discretionary decision making and judgment related to project coordination, trouble-shooting, and adherence to strict deadlines, maintaining project schedule, monitoring program progress, and communicates plans, status, and issues to management
Provides quantitative analysis on various quality measures and health education by planning, collecting and analyzing proper sources of data, and by writing SAS and SQL codes to extract and analyze appropriate data sets. Participates in enterprise-wide data governance and master data management activities.
- Maintains and develops data infrastructures in support of Quality analytics. This will involve the use of SQL in a SQL Server environment. This also requires gathering user requirements (from the HEDIS, QI, and other teams), documenting all aspects of the infrastructure and its processes,
- Becomes proficient in the maintenance and use of the HEDIS dedicated software (currently Inovalon Quality Spectrum). Participates in external vendor communications by collaborating and disseminating reports and defining program descriptions, and by sharing analytical findings.
- Provides technical subject matter expertise while integrating data from multiple entities through the system. Analyzes this integrated data to explain variation, identify opportunities and explain trends.
Develops, tests, and implements dashboard reporting to provide senior leadership and executive staff, as well as other internal DHP customers, with performance data and trend information in an easily accessible and readily understandable format with well-written analytic executive summaries appropriate for presentation
Demonstrates initiative and the ability to work both independently and as part of project teams under minimal general supervision of supervisory or management staff.
Provides project leadership on assigned projects and or activities, including project coordination expertise for complex analytic projects involving cross-departmental/cross-divisional staff.
Performs other duties, tasks or special assignments as needed.
A technical, business or scientific Bachelor's Degree with 3-5 years of related analytical experience.. A focus on QI and/or HEDIS analytics reporting is preferred. Experience working with clinical setting is an advantage.
Minimum of 3-5 years of experience with related business or scientific computer data applications and strong query language knowledge.
Significant query language experience (e.g. SAS, SQL) with demonstrated ability to develop, test, and execute complex analytic processes. Previous experience with common statistical software packages (e.g., SAS, SPSS). Must be comfortable working with large data sets (e.g., 1-5 million records). Should be familiar with some of these: Qlikview, MS Excel, MS Access, Business Objects or other similar software.
Displays considerable judgment in the analysis of problems; the work of this position significantly impacts the quality of care performance of the health plan. Analyzes, researches, and interprets results, variances, and trends, and be effective at solving problems, not just defining or identifying them
Analytic experience must include understanding of and experience with descriptive and inferential statistics, basic regression analysis and modeling, and survey instrument development in clinical, health care, or clinical research setting.
Knowledge and experience working with medical and pharmacy data, provider claims data, and related coding schemas (i.e., ICD-9, CPT, HCPCS, DRG, NDC).
Requires ability to participate in cross departmental and/or cross-divisional analytic or project teams and possess good oral and written communication skills; be an attentive and active listener, and be able to work under pressure, managing multiple projects and deadlines. Must demonstrate a commitment to team work and exceptional customer service
Valid driver's license and personal, reliable vehicle required for work related travel to fulfill job responsibilities.
Develops exception reporting and conducts drill down analysis to proactively identify specific opportunities and risks that warrant assessment and measure a program's success or effectiveness.
Perform the necessary tasks to ensure that the deliverable presented to the customer is accurate and correct given the constraints of the request and the data environment.
Experience with HEDIS rate generation and analytics is preferred
Essential Physical Functions:
Job tasks are primarily sedentary in nature.
Ability to perform fine motor skills while using the computer or writing. Computer use may occur for extended periods exceeding 4 hours.
Ability to hear and converse on the phone and in person.
Ability to continuously perform fine motor tasks, such as computer, writing or phone tasks