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HEDIS Coordination – Data Analyst
| Company | Centene |
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| Location | Texas, USA |
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| Salary | $55100 – $99000 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Mid Level |
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Requirements
- Bachelor’s degree in related field or equivalent experience
- 3+ years of quality improvement or healthcare related experience is required
- Working knowledge of the National Committee on Quality Assurance (NCQA) is preferred
- Working knowledge of HEDIS requirements is preferred
Responsibilities
- Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
- Establish and maintain an action plan to improve HEDIS scores
- Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
- Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
- Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
- Conduct quality audit and maintain all data and process controls to ensure compliance
- Performs other duties as assigned
- Complies with all policies and standards
Preferred Qualifications
- 4+ years of analyzing healthcare Quality data, QA databases, EMR systems, and HIPPA regulations – strongly preferred
- Direct work experience with data analysis, interpreting statistical data, assessing HEDIS performance, resolving data quality issues, and tracking compliance trends
- Proficient in writing SQL queries, extracting and interpreting data for stakeholders is a MAJOR PLUS
- Proficient computer skills utilizing Microsoft Office applications (Excel, Outlook, One Note, Word, Power Point, etc) and be able to navigate between multiple databases
- Organizational skills, time management, agility AND adaptability skills are CRITICAL skills in this role meet KPIs and Quality initiatives
- Experience utilizing multiple avenues of communication (i.e, Email, Phone, Video, and Conferencing Applications)
- Experience and working knowledge with HIPPA regulations, healthcare compliance standards (NCQA, InterQual), and Medicaid insurance practices and regulations is preferred
