Medical Mutual Job - 31433182 | CareerArc
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Company: Medical Mutual
Location: Cleveland, OH
Career Level: Associate
Industries: Banking, Insurance, Financial Services


HEDIS Analyst (Job Family) -- Lead, Senior or Level II Analyst
Supports corporate and departmental strategies and goals for the annual HEDIS submission process. Effectively applies business knowledge and technical expertise to support business initiatives to report clinical quality of care received by members. Works closely with the Quality team to develop year-round strategies to improve quality of care received by members, members' health outcomes. Successfully completing the HEDIS submission lifecycle for multiple submissions. Assuring the accuracy and validity of source data and results and ensuring compliance with HEDIS technical specifications, policies and operating procedures. Collaborating with the HEDIS and Quality Improvement Analytics Manager to develop and monitor annual HEDIS project plans and assist with preparations for the annual HEDIS audit, including development of the HEDIS Road Map. Establishing business rules for accurate use of reporting data fields. Identifying new and maintaining existing data sources to ensure the availability of information for HEDIS submission and reporting purposes. Representing the HEDIS team in collaboration with internal departments for HEDIS improvement. Ensuring all data sent to HEDIS software vendor are accurate and are submitted consistent HEDIS reporting timelines. Identifying data-related issues, conducting root cause analyses, and facilitating resolution of known issues by working directly with end-users of data and IT staff. Working closely with the Quality team and medical record review vendors as needed to ensure that the medical charts meet the standards as outlined by HEDIS specifications. Generating and maintaining thorough and accurate documentation related to data sources, business rules, and reporting policies and procedures. Supporting identification of training opportunities and assisting with mentoring and training peers regarding the HEDIS submission process, Road Map, audit and timeline. Assisting with vendor and auditor relationships and serving as a key HEDIS contact for vendor inquiries and issues. Responsibilities

  • Manage the HEDIS submission lifecycle process for multiple submissions
  • Identifies, plans, and executes HEDIS submission lifecycle process improvement opportunities
  • Serves as a corporate-wide expert regarding the HEDIS submission process, including data sources, measurement, medical records review process and sampling, and annual audit functions
  • Formally mentors, coaches and trains junior-level peers


Education and Experience:
  • BA/BS in health care administration, public health, or a health care related field; Master's degree (MBA, MPH, or MHA) preferred
  • Minimum of one (1) year of HEDIS-specific knowledge and submission experience
  • Experience using certified HEDIS software
  • Demonstrated experience in data extraction (SQL) and analytics programming languages (SAS)

Professional Certification(s):

  • Project Management Professional (PMP) certification preferred

Technical Skills and Knowledge:

  • Experience using certified HEDIS software
  • Intermediate to advanced experience in data extraction (SQL) and analytics programming languages (SAS)
  • Ability to perform advanced queries and retrieve and integrate data from multiple tables and/or sources
  • Demonstrated success with analyzing clinical, claims, pharmacy and encounter data
  • Advanced knowledge and experience with the health insurance industry, and particularly with clinical quality measurement
  • Demonstrated effective and long-term success with communicating in writing, verbally and with delivering presentations
  • Successful project management expertise and experience, a well-developed business sense, the ability to perform in a fast-paced environment, and comfort interacting with internal and external senior leaders are critical to success in the role
  • Working with minimal direction, initiate projects and demonstrate significant flexibility to coordinate complex activities that are often subject to rapid or extensive changes

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:
  • Top Workplace in Northeast Ohio. Year after year we've received this recognition!
  • On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
  • On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
  • Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
  • Business casual attire
Excellent Benefits and Compensation:
  • Competitive compensation plans
  • Employee bonus program
  • 401(k) with company match and an additional company contribution
  • Excellent medical, dental, vision, and disability insurance
An Investment in You:
  • Career development programs and classes
  • Mentoring and coaching to help you advance
  • Education reimbursement up to $5K per year
About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 80 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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