The Expert Analyst is responsible for oversight and coordination of all HEDIS audit and Medical Record Review project functions and deliverables.
- Coordination and oversight all HEDIS audit functions including, but not limited to, the following:
- NCQA HEDIS ROADMAP
- HEDIS audit review (onsite audit)
- Auditor issue log
- Medical record audits including PSV, MRRV and applicable auditor Convenience Samples
- Final rate submissions in IDSS and final PLD submissions to CMS and the HEDIS auditors
- Coordination and oversight of MRR projects which includes, but is not limited to the following:
- MRR project setup in project management tool (QSHR)
- Chase file creation and management with various retrieval sources
- Development of chase logic and measure prioritization
- Provider and chase data scrubbing
- Chase and record management processes
- Measure and retrieval rate tracking and reporting
- Abstraction, overread and QA activities
- OOA projects
- IRR Training and Testing
- Relationships with key HEDIS vendors including timely and accurate MRR project setup and execution
- Post-season analysis projects to identify areas for improvement
- Has an expert-level understanding and knowledge of HEDIS® MA hybrid measures.
- Manages client relationships which includes regular meetings to discuss ongoing projects, project status, key milestones, improvement efforts, and any project risks or issues
- Participates in annual MRR project improvement projects
- Works closely with internal Stars and Data and Analytics teams to meet client needs and ad-hoc requests and participates in weekly meetings to focus on data improvement projects
- Develops and oversees ad-hoc measure training to educate clients and internal staff with difficult measures
- Serves as a key resource for HEDIS question and issue escalations
- Tracks and reports out to leadership weekly on key HEDIS action items and issues
- Participates in annual HEDIS Technical Specification review and reporting
- Participates meetings with auditors, clients, vendors, and other internal staff
- Adheres to detailed project timelines based on NCQA, CMS, auditor, client, vendor, and internal deadlines and processes
- Ability to manage multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters
- Ensures complete, accurate and timely data for reporting purposes.
- Recommends and implements solutions to identified problems/root cause of issues.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.EMPLOYMENT QUALIFICATIONS: EDUCATION:
Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, Epidemiology, Population Health or a related field. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.EXPERIENCE:
Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Ability to manage significant work load and to work efficiently under pressure meeting established deadlines with minimal supervision.
- Expert knowledge and experience with HEDIS measures and data
- Strong communication skills are required to understand, interpret, and communicate ideas.
- Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
- Strong analytical, organizational, planning, and problem-solving skills.
- Ability to effectively interface with employees at all levels.
- Other related skills and/or abilities may be required to perform this job.
- Administer and adhere to corporate and departmental policies, practices and procedures.
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
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