HEDIS Data Analyst

3 weeks ago


Philadelphia, Pennsylvania, United States Jefferson Health Plans Full time
About the Role

We are seeking a highly skilled HEDIS Data Analyst to join our team at Jefferson Health Plans. As a key member of our Healthcare Economics (HCE) team, you will play a critical role in providing clinical and financial analyses to support business decision-making.

Key Responsibilities
  • Assist the HEDIS Team with all HEDIS-based reporting and analysis, compiling, verifying, and analyzing data to monitor HEDIS results.
  • Support the Quality Management Department with HEDIS performance and regulatory reporting, verifying data sources and measure results, and preparing member-level detail.
  • Analyze results to understand business implications and propose future program enhancements.
  • Prepare required regulatory reports, documenting challenges encountered and resolution methods.
  • 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 and assist with DHS-related reports 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.
Requirements
  • 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.
Preferred Skills
  • 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 an 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.

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