Digital HEDIS & Quality Analytics Lead

EmblemHealth; New York (NY); On-site; USD 100,000 - 160,000; Full time

Job summary

EmblemHealth seeks an analytics professional to provide analysis, reporting, and predictive modeling for quality initiatives within the HEDIS strategy.

You will automate reporting, manage data governance of clinical sources, and work with vendors, IT, and auditors to ensure digital readiness for quality measures. You will build dashboards and present findings to stakeholders to support strategic decisions.

Qualifications

• Bachelor’s degree in analytical/quantitative field including healthcare management, finance, business, math, engineering or related fields.
• Master’s degree preferred.
• 4–6+ years of relevant, professional work experience (Required).
• 3+ years of experience in managed care/healthcare analytics (Required).
• Advanced knowledge of HEDIS and Medicare Stars, including experience with electronic quality measures (Required).
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) (Required).
• Advanced experience with relational database applications (SAS, R, SQL or others) (Required).
• Experience with automating processes using programming languages (Python, VBA, R, SAS, C++ or others) (Required).
• Experience with data visualization tools (Power BI, Tableau) (Required).
• Self-starter capable of end-to-end independent project development (Required).

Responsibilities

• Implement reporting and reconciliation workflows and document processes.
• Perform medical trend studies related to quality initiatives.
• Identify data improvement opportunities from HEDIS/QARR/Star outputs and data issues.
• Collaborate with IT and vendors to plan digital readiness including for FHIR.
• Identify new data sources for clinical data ingestion (EHRs, HIEs, data aggregators).
• Conduct data collection and data mining to support internal and external customers.
• Develop complex statistical analyses of quality metrics for Medicare and other populations.
• Maintain automated quality dashboards and measure profiles using visualization tools.
• Provide analytical support for design and maintenance of quality improvement initiatives; build self-service reports.
• Analyze business problems affecting member quality experiences and STARS ratings.
• Present findings to internal partners and drive further analysis.
• Collaborate with quality management teams on improvement initiatives.

Skills

HEDIS knowledge

Medicare Stars experience

Statistical modeling

Education

Bachelor’s Degree in analytical/quantitative field

Master’s Degree preferred

Tools

SAS

R

SQL

Power BI

Tableau

Excel

Python

VBA

Job description

EmblemHealth seeks an analytics professional to provide analysis, reporting, and predictive modeling for quality initiatives within the HEDIS strategy.

You will automate reporting, manage data governance of clinical sources, and work with vendors, IT, and auditors to ensure digital readiness for quality measures. You will build dashboards and present findings to stakeholders to support strategic decisions.