QOI Project Analyst

Found in: Careerbuilder One Red US C2 - 2 weeks ago

Eden Prairie MN United States UnitedHealthcare Full time

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.



Our Quality Reporting Operations team is vital to our success and  driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.



This position is fully Remote.



You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.



Primary Responsibilities:



  • Demonstrate understanding of relevant organizations' operations, products, applications, strategies and processes to effectively support Quality Reporting Operations using relevant tools and applications

    • Submission of the NCQA Health Plan Roadmap General Information, Appendix and Attestation
    • Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
    • Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS® project (Initial, Refresh, Final) on primarily less complex projects
    • Perform all MRR project build steps, to ensure each hybrid MRR project is set up according to business requirements
    • Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project, including validations of these data loads
    • Monitor rates, MRSS and exclusions within the HEDIS® software, coordinating clinical review when necessary
    • Complete all HEDIS® software upgrade steps as required
    • Complete all final admin and hybrid project processing including validation of all exclusions and QA of all final data and rates
    • Create and validate all final hybrid frozen counts and deliver to CHCA
    • Creation  and Q/A of IDSS exports and submission to NCQA
    • Creation and Q/A of PLD exports and submission to CHCA and/or CMS, if applicable
    • Submission of State required reporting, if applicable
    • May also assist in supporting chase status updates, chase activations, query exports and special request data analysis or validations

  • Monitor on-going progress of business processes

    • Monitor compliance against relevant process requirements and timelines
    • Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts
    • Ensure all NCQA, CHCA, FEHB, State and other HEDIS® reporting requirements and deadlines are met

  • Monitor and analyze business process information to identify key issues, trends, and potential root causes that point to improvement opportunities

    • Participate in analysis of project outcomes to generate data driven recommendations for process improvement
    • Participate in work groups to implement process improvement and/or in preparation to meet business requirements
    • Participate in HEDIS® software system testing efforts to ensure project preparedness
    • Use a process driven approach to identify root cause and process improvement opportunities

  • Demonstrate and remain current in understanding of relevant regulations and systems

    • Complete all required training for job role and stay current on all HEDIS® technical specifications and software systems
    • Develop proficiency in HEDIS® software tools and other required quality metric reporting specifications
    • General knowledge of HEDIS® impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.

  • Summarize and communicate proposed solutions with the appropriate audiences

    • Resolve all CHCA (Auditor) Issue Log concerns for projects assigned

  • Communicate potential impacts and risks associated with implementing proposed solutions to manager and team leaders

    • Timely escalation of all issues and barriers to Manager, Quality Reporting Operations (MQP)

  • Assesses and interprets customer needs and requirements
  • Identifies solutions to non-standard requests and problems
  • Solves moderately complex problems and/or conducts moderately complex analysis
  • Works with minimal guidance
  • Translates concepts into practice


You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:



  • Associates degree or equivalent related experience
  • 6+ months HEDIS® or NCQA or CMS Stars experience
  • Healthcare/Health plan experience
  • Solid experience with MS Word for business communications
  • Experience conducting moderately complex analysis with large data sets to identify trends and/or potential risk
  • Intermediate to Advanced level of experience with Outlook
  • Solid proficiency with MS Excel conducting data manipulation and analysis
  • Demonstrated ability to manage and prioritize deliverables


Preferred Qualifications:



  • Bachelor's degree or higher
  • 2+ years of HEDIS operations experience
  • Experience with medical claims systems
  • Experience working with HEDIS® medical record vendors
  • Experience using CMS, NCQA referencing websites
  • Solid knowledge of managed care requirements related to clinical quality
  • Proficient with certified HEDIS® software


Soft Skills:



  • Ability to work without a lot of direction
  • Team player
  • Solid communication skills
  • Organized
  • Ability to manage multiple projects/priorties at a time


*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy


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