HEDIS Analyst Job Listing at Medical Mutual in OH (Job ID 2500183)

Description

Note: this is a fully remote opportunity. Eastern Time Zones preferred.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Produces reporting and analyses to identify actionable opportunities for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report performance on key quality indicators, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), STARS, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Healthcare Outcomes Survey (HOS). Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care. Supports quality improvement initiatives by collaborating with more senior Analysts and management. Consults with and informs business stakeholders of trends, opportunities and risks. 

Responsibilities

·         Provides analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers. Produces in depth, and customized trend reporting across multiple systems and delivers recommendations to improve quality metrics.  Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and/or providers.

·         Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.

·         Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.  Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.

·         Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation.

·         Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.

·         Orients, trains and assists more junior-level Analysts.

·         Participates in required training and performs other duties as assigned.

Qualifications

Education and Experience

·         Bachelors Degree in health care administration, public health, or related field.

·         3 years' experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience. programs.

Technical Skills and Knowledge

·         Ability to identify opportunities and propose solutions.

·         Ability to develop and produce complex reports and dashboards.

·         Ability to draft analytical assessments and summarize content in simplified language.

·         Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.

·         Advanced knowledge of health insurance industry and health plan operations.

·         Ability to utilize certified HEDIS software.

·         Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.

·         Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.

·         Advanced proficiency in database reporting (SQL) and analytics programming languages (SAS) and data visualization tools such as Tableau.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.