HEDIS Expert Analyst

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

United States, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p> https://advantasure.com/

keywords: job description,coordinate,project management,analysis,goals,relations,other duties,education & experience,knowledge,skills


Competitive Compensation and Benefits Package

Overview: <br />The Expert Analyst is responsible for oversight and coordination of all HEDIS audit and Medical Record Review project functions and deliverables.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Coordination and oversight all HEDIS audit functions including, but not limited to, the following: <ul> <li>NCQA HEDIS ROADMAP</li> <li>HEDIS audit review (onsite audit)</li> <li>Auditor issue log</li> <li>Medical record audits including PSV, MRRV and applicable auditor Convenience Samples</li> <li>Final rate submissions in IDSS and final PLD submissions to CMS and the HEDIS auditors</li> </ul> </li> <li>Coordination and oversight of MRR projects which includes, but is not limited to the following:</li> <li>MRR project setup in project management tool (QSHR)</li> <li>Chase file creation and management with various retrieval sources</li> <li>Development of chase logic and measure prioritization</li> <li>Provider and chase data scrubbing</li> <li>Chase and record management processes</li> <li>Measure and retrieval rate tracking and reporting</li> <li>Abstraction, overread and QA activities</li> <li>OOA projects</li> <li>IRR Training and Testing</li> <li>Relationships with key HEDIS vendors including timely and accurate MRR project setup and execution</li> <li>Post-season analysis projects to identify areas for improvement</li> <li>Has an expert-level understanding and knowledge of&nbsp;HEDIS&reg;&nbsp;MA hybrid measures.</li> <li>Manages client relationships which includes regular meetings to discuss ongoing projects, project status, key milestones, improvement efforts, and any project risks or issues</li> <li>Participates in annual MRR project improvement projects</li> <li>Works closely with internal Stars and Data and Analytics teams to meet client needs and ad-hoc requests and participates in weekly meetings to focus on data improvement projects</li> <li>Develops and oversees ad-hoc measure training to educate clients and internal staff with difficult measures</li> <li>Serves as a key resource for HEDIS question and issue escalations</li> <li>Tracks and reports out to leadership weekly on key HEDIS action items and issues</li> <li>Participates in annual HEDIS Technical Specification review and reporting</li> <li>Participates in meetings with auditors, clients, vendors, and other internal staff</li> <li>Adheres to detailed project timelines based on NCQA, CMS, auditor, client, vendor, and internal deadlines and processes</li> <li>Ability to manage&nbsp;multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters</li> <li>Ensures complete, accurate and timely data for reporting purposes.</li> <li>Recommends and implements solutions to identified problems/root cause of issues.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Epidemiology, Population Health or a related field.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.&nbsp;</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Ability to manage significant work load and to work efficiently under pressure meeting established deadlines with minimal supervision.</li> <li>Expert knowledge and experience with HEDIS measures and data</li> <li>Strong communication skills are required to understand, interpret, and communicate ideas.</li> <li>Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li> <li>Strong analytical, organizational, planning, and problem-solving skills.</li> <li>Ability to effectively interface with employees at all levels.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> <li>Administer and adhere to corporate and departmental policies, practices and procedures.</li> </ul>