Sr. Performance Quality Analyst

United States Minor Outlying Islands

Remote position available

Job Description

Develops documents and programs in support of state performance measures, HEDIS projects and risk adjustment initiatives. He/she conducts in-depth data analysis and interpretation, HEDIS reporting, and other related tasks within the Quality team. He/she is responsible for conducting quality assurance on data collection, data processing, data analysis and reporting. The role is also responsible for conducting HEDIS results analysis based on business needs and presenting the results effectively to internal and external stakeholders and senior management. Provides day to day reports and strategic analysis to drive performance metrics within the quality department. Reports to Corporate/National health plan leaders to drive state, federal and NCQA benchmarks.
  • Designs and produces timely and meaningful analysis and data interpretation regarding large health care related datasets, related to provider billing and coding for HEDIS, Risk Adjustment, state specific programs (such as Quality Improvement Programs/Performance Improvement Programs within quality), issued by state agencies, and other associated company initiatives 
  • Collaborates with analytics team and other internal business partners to drive outcomes within the local health plan and national market 
  • Utilizes software programs such as SAS, SQL, Excel, heat mapping and/or other business intelligence tools to extract needed data 
  • Writes original code and modifies existing code, as needed, to execute projects to specifications, and assists in the development of these specifications 
  • Interprets data accurately and produces clear and comprehensive written analyses, graphics, tables, etc. for diverse internal and external audiences 
  • Plans, organizes, and prioritizes assigned projects, creating and managing work plans that reflect the tasks, timeframes, and processes required to successfully complete each 
  • Assists with development, implementation, and documentation of quality improvement processes to ensure that reported data is accurate and reliable 
  • Maps multiple data sources for HEDIS reporting; generates reports from the data warehouse and HEDIS software 
  • Conducts quality assurance on data loaded into the HEDIS software, reviews results for accuracy and prepares for annual HEDIS compliance audits 
  • Maintains and builds new databases as needed 
  • Guides other Data Analysts on evaluating data and meeting customer specifications and business needs 
  • Performs coding/billing analysis to determine missed opportunities (for both HEDIS and Risk Adjustment); performs provider attribution gap analysis for mapping and process improvement 
  • Performs in-depth HEDIS data analysis for resource management; produces road maps for audit compliance  
  • Responsible for HEDIS in-period reporting and monitoring 
  • Documents data collection processes with other teams to ensure collaboration and consistency 
  • Ensures understanding of customer needs by proactively clarifying scope and requirements and keeping customers apprised of project status through effective communication 
  • Supports customer understanding of analytical findings through effective presentation of results to individuals and groups 
  • Achieves high-quality deliverables by assuring accuracy and thoroughness in executing projects 
  • Manages multiple projects by effectively prioritizing work and communicating workload issues to management 
  • Provides technical support for HEDIS sampling, medical records retrieval and reviewing 
  • Other projects and duties as assigned 

General Job Information

Title

Sr. Performance Quality Analyst

Grade

25

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

7/2/2019

Date Requisition Created

6/30/2019

Work Experience

Analytics/Informatics

Education

Bachelors: Computer and Information Science (Required), Bachelors: Mathematics (Required), Bachelors: Statistics (Required), Masters: Computer and Information Science, Masters: Mathematics, Masters: Statistics

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Preferred Qualifications

  • Master’s degree in Math, Statistics, Biostatistics, Computer Science, or other quantitative disciplines required 
  • Proficiency with MS SQL (queries) and Tableau preferred 
  • Prior experience with HEDIS software preferred 
  • Advanced knowledge of MS Access, to create ad-hoc reports, forms and design databases 
  • Clinical code knowledge related to claims/utilization preferred 

Required Qualifications

  • Bachelor’s or above degree in Math, Statistics, Biostatistics, Computer Science, or other quantitative disciplines required 
  • 7+ years of related analytical experience required 
  • Extensive expertise in hybrid strategy, coding and chase logic 
  • Strong analytical skills required 
  • Ability to effectively interact with, and present findings to customers at various levels of the organization 
  • Advanced SAS data step, SAS macro language, and other SAS procedures required 
  • Proficiency with MS SQL (queries) and Tableau required 
  • Clinical code knowledge related to claims/utilization required 
  • Ability to document processes and analyses for reference/re-use required 
  • Excellent technical, interpersonal, written and oral communication skills required 
  • Proficient in MS Office 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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