The Quality Data analyst is responsible for supporting the Quality Department in the administration of HEDIS, Credentialing, Accreditation and Delegation data analysis. Duties include participating in HEDIS activities such as running queries, validating accuracy of data, running TierMed engine, producing provider specific reports on HEDIS and other quality measures; designing databases; collecting and analyzing credentialing/health care data and participating in clinical and non-clinical studies; aggregating data across regions and identifying areas of excellence and those that need improvement. Excellent analytical skills are required for both qualitative and quantitative analysis.     

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Collaborate with IT on HEDIS, Credentialing, and other system-driven data.
• Work with IT or other departments to produce monthly provider specific reports for HEDIS data utilizing TierMed.
• Content expert for Tiermed, including engine and data viewer.
• Provide accurate and timely data sets to software vendor for HEDIS data reporting.
• Analyze HEDIS medical record samples to validate accuracy and completeness.
• Create and implement an ICQ process for validating administrative data.
• Build and maintain auditor approved internal databases to collect additional HEDIS related data.
• Analyze data from automated, direct and interactive, outreach calls.
• Review files and create/run various reports.  Forward errors to the appropriate department for resolution.
• Assist in design, implementation and completion of quality improvement studies according to NCQA standards.

• Create databases for use in quality improvement initiatives and train staff on use.
• Create aggregate reports across regions, analyze results and present to Corporate Quality Improvement Committee and other meetings.
• Run credentialing reports from Cactus, PBD, and QNXT to ensure accuracy and timeliness of credentialing files.
• Run and analyze credentialing reports to verify CMS compliance, as needed.
• Maintain files on databases, reports and supporting documents.
• Create reports for CMS, and NCQA accreditation
• Assists and supports the Quality Department as required

• Other duties as requested

Minimum qualificationS:

• A Bachelor's degree in Computer Science, Computer Engineering, or Management Information Systems, or equivalent work experience with technical training, is required.    
• At least 3 years of recent healthcare experience in HEDIS reporting is preferred.
• Healthcare insurance industry experience desired.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Must be able to manage multiple assignments with staggered deadlines.
• Experience in programming, health care data analysis and interpretation, quality studies and reports required.
• Must have strong analytical abilities and a systematic approach to problem solving.
• Must have good interpersonal, communication, and documentation skills.
• Hands on experience with automated testing tools and project tracking software is preferred.
• Experience writing SQL Server queries is required.
• Extensive back-end testing experience is required.
• Experience in software testing is required.
• Ability to analyze and evaluate data and problems, develop alternative solutions, and identify trends and patterns.

• Advanced skills with ACCESS, EXCEL and managed care network information system data collection required, moderate to advanced skill with SAS and similar software required.

• Knowledge of  NCQA and HEDIS required and managed care preferred.
• Knowledge of medical terminology, CPT, HCPCS and ICD-9 coding preferred.
• Professional attitude and team player, with ability to work independently.
• Ability to comprehend technical documents.
• Flexible with the ability to shift priorities on short notice.

CONFIDENTIALITY:

This position is exposed to patient medical record information that if revealed inappropriately would be against company policy, professional ethics and integrity.

PHYSICAL DEMANDS/WORK ENVIRONMENT:

Must be able to work appropriate amount of hours to meet critical deadlines.