Lead Analyst, Digital HEDIS & Quality Analytics - (Remote)

EmblemHealth; New York, Northern (NY, KY); Hybrid; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth seeks a Lead Analyst for Digital HEDIS & Quality Analytics to drive the digital strategy within the quality measurement analytics team. You will lead automation of reporting, manage data governance, and support QA for HEDIS/QARR/Star metrics across available data sources.

You will prepare dashboards, perform advanced analyses, and collaborate with IT, vendors, and auditors to ensure digital readiness, including FHIR readiness.

Qualifications

• Bachelor’s or higher in analytical/quantitative field; Master’s 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 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, or others) (Required).
• Experience with data visualization tools (Power BI, Tableau) (Required).
• Demonstrated self-starter with ability to develop projects end to end independently (Required).

Responsibilities

• 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.

Skills

HEDIS / Medicare Stars

Power BI

Tableau

Python

R

SAS

SQL

MS Office

Data governance

Self-starter

Education

Bachelor’s Degree in analytical/quantitative field

Master’s Degree preferred

Tools

SAS

R

SQL

Job description

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visitemblemhealth.com .

If you’rean EmblemHealth employee, unlock your career potential by signing in at the top of this page. Access your employee profile to view internal job postings and explore new opportunities.

Lead Analyst, Digital HEDIS & Quality Analytics - (Remote)

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)

Additional Information

• Requisition ID: 1000003328
• Hiring Range: $77,760-$149,040

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.