Lead Analyst, Digital HEDIS & Quality Analytics

EmblemHealth; New York (NY); On-site; USD 120,000 - 180,000; Full time

Job summary

EmblemHealth seeks a senior analytics lead to drive the quality department's digital HEDIS strategy and data governance. You will oversee automated reporting, trend analyses, and data ingestion from diverse sources to support Star metrics and NCQA readiness.

Working with IT and external vendors, you will develop advanced statistical models for Medicare and other populations, and deliver self-service dashboards to inform strategic decisions for stakeholders.

Qualifications

• Bachelor’s degree in analytical/quantitative field (healthcare, finance, math, engineering, economics).
• Master’s degree preferred.
• 5–8+ years of relevant professional work experience (Required).
• 5+ years of experience in managed care/healthcare analytics (Required).
• Advanced knowledge of HEDIS and Medicare Stars, including 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, or others) (Required).
• Experience with data visualization tools (Power BI, Tableau) (Required).
• Demonstrated self-starter with end-to-end project development (Required).

Responsibilities

• Lead the implementation of the quality department digital HEDIS strategy and analytics.
• Develop, automate, and manage reporting workflows and data governance for HEDIS/QARR/Star metrics.
• Lead 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 ensure digital readiness (FHIR).
• Generate and present analytical dashboards to stakeholders for strategic decisions.
• Develop advanced statistical analyses for Medicare, State Programs, and other populations.
• Create automated quality dashboards and measure profiles using visualization tools.
• Guide design and maintenance of quality improvement initiatives and self-service reports.
• Assist quality teams on improvement initiatives and end-to-end projects.

Skills

HEDIS/Medicare Stars

SQL

SAS

R

Python

Power BI/Tableau

Data visualization

Data governance

Healthcare analytics

MS Office

Education

Bachelor’s degree in analytical/quantitative field

Master’s degree preferred

Tools

SAS

R

SQL

Tableau

Power BI

Job description

Lead the implementation of the quality department digital HEDIS strategy under the quality measurement analytics team. Lead efforts to continually improve data capabilities and quality of department analysis and reporting. Develop and implement automation of manual reporting and analysis of business implications and trends. Develop, automate, and manage the intake, use and data governance of clinical and supplemental data sources to support all HEDIS/QARR/Star metrics. Identify areas of opportunity and new data sources to support quality metrics. Work closely with quality department, IT, NCQA certified HEDIS vendor and auditors to ensure readiness for digital quality. Prepare and present analytical dashboards and data to key stakeholders to support strategic decision making.

Principal Accountabilities

• Develop, implement, and manage reporting and reconciliation workflows and document processes.
• Lead medical trend studies as they pertain to quality initiatives.
• Identify data improvement opportunities through review of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues.
• Collaborate with IT and others to plan and execute digital readiness, including readiness for FHIR.
• Engage with vendors, providers, and others to identify new sources of clinical data ingestion (e.g. data aggregators, EHRs, HIEs, etc).
• Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
• Lead the development of complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
• Develop and maintain automated quality dashboards and measure profiles utilizing data visualization tools.
• Provide analytical and technical guidance for design, development and maintenance of quality improvement and wellness initiatives. Build self-service reports to be used by the quality department.
• Identify and analyze business problems related to quality experience of member, particularly related to how members receive care and other factors influencing the STARS rating.
• Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
• Collaborate with internal quality management teams to assist on quality improvement initiatives.

Qualifications

• Bachelor’s Degree in analytical/quantitative field including healthcare management, finance, business, mathematics, engineering, applied stats/economics, or any other related fields
• Master’s Degree preferred
• 5 – 8+ years of relevant, professional work experience (Required)
• 5+ years of experience in managed care/healthcare analytics (Required)
• Advanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources (Required)
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) (Required)
• Advanced experience with relational database applications (such as SAS, R, SQL, or others). (Required)
• Experience with improving and automating processes using programming languages/software (Python, VBA, R, SAS, C++, or others) (Required)
• Experience with and proficient in statistical software/programs (such as SAS, R, Stata, Minitab or others) (Preferred)
• Experience with and proficient in data visualization tools (such as Power BI, Tableau) (Required)
• Demonstrated self-starter with ability to develop projects end to end independently (Required)