Description
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.
Supports corporate and departmental strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members' health outcomes.
Note: This is a fully remote opportunity. Eastern Time Zones preferred.
Responsibilities
HEDIS Analyst II
Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap. To include data documentation, compilation, reconciliation, and research. Works directly external HEDIS/NCQA auditor to resolve any items on Issue Log.
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 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.
Produces routine to moderately complex HEDIS reporting to support clinical Quality initiatives to improve member health.
Orients and trains more junior-level Analyst
Participates in required trainings and performs other duties as assigned.
HEDIS Analyst III
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.
Sr HEDIS Analyst
Leads analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers. Leads production of 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. Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation
Orients, assists, trains, mentors, coaches and reviews work of more junior-level Analyst. May supervise staff in absence of Manager
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.
Participates in required training and performs other duties as assigned.
Lead HEDIS Analyst
Schedules, assigns, and monitors projects and prioritizes work based on competing deadlines. Provides peer review, training, and oversight. Tracks work and provides regular progress updates to team and department leadership, and internal and external stakeholders. May provide input in hiring, development, and performance evaluations of more junior analysts.
Helps devise and implement clinical quality analytic strategy, priorities, and continuous improvement. Oversees work unit creation of data analyzes and reports. Presents results to inform strategic decision making. Collaborates with internal and external stakeholders to provide appropriate analyses and makes value-added recommendations beyond what is requested.
Leads collaboration with team, department leadership, and internal stakeholders to gather, document and execute analytic and reporting requirements in compliance with HEDIS technical specifications, policies, and operating procedures. Explains technical details, relevance, and implications of analytic results to diverse audiences. Incorporates feedback to improve content and format of deliverables. Builds and inspires collaborative relationships within the team and with internal and external stakeholders.
Leads in the development and collaborative enhancement of analytic tools and deliverables. Actively participates in department and team meetings. Maintains up to date knowledge and understanding of technical specifications for all HEDIS measures, regulations, and best practices. Serves as a Subject Matter Expert to management and other departments. Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation.
Performs other duties as assigned.
Qualifications
Qualifications
HEDIS Analyst II
Education and Experience:
Bachelors Degree in health care administration, public health, or a related field.
2 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience.
Technical Skills and Knowledge:
Knowledge of health insurance industry.
Knowledge of project management.
Ability to draft analytical assessments and summarize content in simplified language.
Ability to execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
Intermediate proficiency in database reporting (SQL) and analytics programming languages (SAS).
HEDIS Analyst III
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.
Sr HEDIS Analyst
Education and Experience:
Bachelors Degree in health care administration, public health, or related field
Master's degree (MBA, MPH, or MHA) preferred
5 years progressive experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience
Technical Skills and Knowledge:
Ability in 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.
Advanced proficiency in database reporting and data visualization tools including SQL, SAS, and Tableau.
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.
Lead HEDIS Analyst
Education and Experience:
Bachelor's degree in healthcare administration, business administration, information technology or a related field .
Master's degree (MBA, MPH, or MHA) preferred.
7 years progressive experience as a Clinical Quality Data Analyst or equivalent experience conducting analyses and delivering analytic results in a health care, health insurance, consulting, or delivery organization.
HEDIS experience preferred.
Technical Skills and Knowledge:
Advanced knowledge of health plan operations, data sources, and data structures, including trends and drivers of quality. Solid understanding of claim submissions and database management.
Advanced knowledge of Extract, Transform, and Load (ETL) data processes.
Advanced knowledge of HEDIS, NCQA and CMS Stars quality metrics and the ability to apply concepts to business operations.
Advanced knowledge of health plan data sources.
Advanced skills in database reporting and expertise in data extraction and analytical programming languages (SAS, SQL), and data visualization tools (Tableau).
Strong project management skills.
Demonstrated ability to draft analytical assessments and summarize content to non-technical audience.
Ability in 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 #LI-JT1 #LI-REMOTE
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.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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