Manager, HEDIS - Jefferson Health Plan

Job Duties

• Able to work in a constant state of alertness and safe manner
• Manage the entire HEDIS and Pennsylvania EQRO process
• Supervise and manage analyses for senior management and other departments to assure accuracy and integrity of work performed and relevance to the business needs identified.
• Manage and motivate analysts to meet and exceed service requirements and functional objectives
• Coach and lead HEDIS team to continuously improve performance and value
• Work with other department leaders to define and implement their reporting needs with regard to HEDIS and serve as a broker of available information
• Assure that HEDIS staff meet the requirements of their reporting departments and that practices are in compliance with company standards
• Cookordinate, assign and respond to data requests from other departments. Maintain and foster a collaborative relationship with these departments
• Participate in companywide initiatives such as new system implementations, quality and process improvement. Ensure that data and reporting needs are considered in plan-wide initiatives
• Create accurate and meaningful utilization and outcome analysis, trend and other reports for departmental and management HEDIS related decision-making using Hyperion, MS Access, MS Excel and other reporting tools as necessary.
• Help determine optimal analysis and presentation of medical data to improve service quality. Direct use of dashboards, presentations, and spreadsheet reports accordingly
• Work with IS to ensure that optimal business and reporting tools are available for HEDIS, STARS and other company users
• Maintain data initiatives with IS, Operations and other departments to ensure accuracy and consistency and to avoid duplication of effort
• Understand and communicate to HEDIS staff how changing business practices will affect data and reporting, and implement the necessary changes efficiently and accurately
• Other responsibilities as assigned.

Minimum Qualifications

• Bachelor’s Degree or higher degree in actuarial science, mathematics, statistics or other analytical field of study
• 4 years of data reporting and analysis experience with at least 2 years of clinical/healthcare data experience in managed care and/or medical quality assurance setting or other relevant experience
• Experience with Medicaid and Medicare insurance and populations
• Experience with provider coding practices using CPT, ICD-10 codes, and DRG’s
• Understanding of delivery and reimbursement of medical services in a managed care environment
• Familiarity with the role disease management, utilization management and care management play in a managed care organization
• HEDIS program management required
• Proven leadership or mentoring skills with a data analysis team
• Strong problem-solving, quantitative and analytical skills
• Ability to use business intelligence query tools, computer spreadsheet (Excel), and database (Access and others, including Visual Basic) at advanced level
• Ability to manage technical staff; management experience a plus
• Proven skills with data presentation including charts, graphs and other exhibits
• Ability to communicate effectively both orally and in writing
• Ability to negotiate workable solutions to customer needs
• Ability to learn quickly and implement knowledge of new technical processes with assistance of business unit experts
• Ability to handle multiple responsibilities and changing priorities
• Excellent organizational skills