Principal Analyst - HEDIS

<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>

Southfield, 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>

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Competitive Compensation and Benefits Package

Overview: <p><strong>SUMMARY:</strong>&nbsp;&nbsp;&nbsp;</p> <p>The Principal Analyst is responsible for planning, organizing, directing, implementation, and leading HEDIS department and client assignments.&nbsp; This position operates within broad objectives to ensure optimum utilization of manpower and budget.&nbsp; This position is responsible for management of client HEDIS audit and medical record review projects, in addition to client management and reporting.&nbsp; This role researches, compiles, and analyzes appropriate and relevant data&nbsp;to identify opportunities to recommend and drive execution<strong>&nbsp;</strong>of process efficiencies in assigned business units to achieve targeted levels of improvement in key operational performance metrics. &nbsp;</p>
Responsibilities: <ul> <li>Leads and develops team members which may include direct reports.</li> <li>Responsible for the development and delivery of multiple concurrent projects/programs that encompass client HEDIS audit and medical record review.</li> <li>Supports various initiatives in requirements definition, documentation of current and future state business capabilities, process development, process flows, training, and internal/external communications.</li> <li>Lead client engagement efforts related to annual HEDIS audit and medical record review.</li> <li>Performs process verification/validation audits and presents findings and actionable recommendations.</li> <li>Designs performance feedback systems to assess the resolution of business process deficiencies and installs appropriate controls.</li> <li>Provides expertise in analytical methodology, including data analysis, used to facilitate data driven decision making, including the collection and monitoring of metrics used to assess, prioritize, and select improvement projects.</li> <li>Benchmarks industry best practices to measure organization position.</li> <li>Consults, develops, and ensures compliance in the use of competitive production and performance standards.</li> <li>Initiates and leads problem solving efforts working closely with internal and external stakeholders.</li> <li>Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.</li> <li>Possesses and maintains an extensive comprehensive knowledge of Advantasure business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.</li> <li>Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.</li> <li>Develops lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.</li> <li>Investigates, reviews, recommends, communicates, and implements solutions which identify problems/root cause of issues.</li> <li>Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.</li> <li>Independently develops and plans reports, papers, and/or other materials in a clear and concise manner.</li> <li>Provides expertise and guidance to unit and corporate staff as required.</li> <li>Acts as a liaison between corporate business areas and participates in group or committee discussions.&nbsp;</li> </ul> <p><em>This position description identifies the responsibilities and tasks typically associated with the performance of the position.&nbsp; Other relevant essential functions may be required.</em></p>
Requirements: <p><strong>EDUCATION:</strong></p> <p>Bachelor&rsquo;s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Public Health, Epidemiology, or a related field.&nbsp; Master&rsquo;s degree in a related field is preferred.&nbsp; Relevant combination of education and experience may be considered in lieu of degree.&nbsp; Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp; Certification or progress toward certification is highly preferred and encouraged.</p> <p><strong>EXPERIENCE:</strong></p> <p>Seven years experience in a related field, typically in two subject areas (e.g. process improvement, project planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.</li> <li>Strong knowledge of HEDIS technical specifications and NCQA audit requirements</li> <li>Prior experience in leading a HEDIS medical record review project</li> <li>Ability to work independently, within a team environment, and communicate effectively with employees and client staff at all levels.</li> <li>Excellent organization skills and ability to effectively multi task in a dynamic and fast paced environment.</li> <li>Ability to lead and facilitate cross functional team meetings.</li> <li>Working knowledge of project management disciplines and methods.</li> <li>Excellent knowledge and use of existing software packages (Visio, Minitab, Project, PowerPoint, Excel, Word).</li> <li>Knowledge of HEDIS and Medicare Advantage Stars &nbsp;programs</li> <li>Working knowledge of healthcare data</li> <li>Ability to&nbsp;understand and apply statistical inference.</li> </ul> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p> <p>The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.&nbsp;</p>