Lead Analyst, Digital HEDIS & Quality Analytics - (Remote)

About the role

Lead the implementation of the quality department digital HEDIS strategy under the quality measurement analytics team. Drive efforts to continually improve data capabilities and the quality of department analysis and reporting. Develop and implement automation of manual reporting and analysis of business implications and trends. Manage the intake, use, and data governance of clinical and supplemental data sources to support all HEDIS/QARR/Star metrics. Identify areas of opportunity and new data sources to support quality metrics. Collaborate with the quality department, IT, NCQA-certified HEDIS vendor, and auditors to ensure readiness for digital quality. Prepare and present analytical dashboards and data to key stakeholders to support strategic decision-making.

Responsibilities

• Develop, implement, and manage reporting and reconciliation workflows; document processes.
• Lead medical trend studies as they pertain to quality initiatives.
• Identify data improvement opportunities through review of HEDIS/QARR/Star reports and data outputs, detecting data acquisition, capture, and system error issues.
• Collaborate with IT and others to plan and execute digital readiness, including readiness for FHIR.
• Engage with vendors, providers, and others to identify new sources of clinical data ingestion (e.g., data aggregators, EHRs, HIEs).
• Perform research and collection of data, including data mining and reporting, provided to various internal and external customers.
• Lead the development of complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
• Develop and maintain automated quality dashboards and measure profiles using data visualization tools.
• Provide analytical and technical guidance for the design, development, and maintenance of quality improvement and wellness initiatives.
• Build self-service reports for use by the quality department.
• Identify and analyze business problems related to the quality experience of members, particularly how members receive care and other factors influencing the STARS rating.
• Present analytical findings to internal business partners, leading discussions and providing further analysis as needed.
• Collaborate with internal quality management teams to assist on quality improvement initiatives.

Requirements

• Bachelor’s Degree in an analytical/quantitative field (e.g., healthcare management, finance, business, mathematics, engineering, applied stats/economics, or related fields).
• Master’s Degree preferred.
• 5–8+ years of relevant, professional work experience.
• 5+ years of experience in managed care/healthcare analytics.
• Advanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources.
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access).
• Advanced experience with relational database applications (e.g., SAS, R, SQL).
• Experience improving and automating processes using programming languages/software (e.g., Python, VBA, R, SAS, C++).
• Experience with and proficiency in statistical software/programs (e.g., SAS, R, Stata, Minitab) preferred.
• Experience with and proficiency in data visualization tools (e.g., Power BI, Tableau).
• Strong communication skills (verbal, written, presentation, interpersonal).
• Demonstrated self-starter with the ability to develop projects end-to-end independently.

Pay

$77,760–$149,040