HEDIS Data Analyst

Why Choose Jefferson Health Plans?
We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.
While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Impact on the communities we service

We are hiring a HEDIS Data Analyst to join our team!

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.

As the HEDIS Data Analyst, your daily duties may include…

• 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.

Qualifications:

• B.S. or higher degree in actuarial science, mathematics, statistics or other analytical field of study.
• 3 to 5 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.

Skills, We Value

• 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