Lead Quality/STARS Technical Analyst- remote - MediGold

Mount Carmel Health System; Columbus (OH); Remote; USD 75,000 - 95,000; Full time

Job summary

A leading healthcare organization in Central Ohio is seeking a Lead Quality/Stars HEDIS and Technical Analyst. This role involves designing processes for data management, developing analytical tools, and ensuring compliance with HEDIS reporting. The ideal candidate will have a strong background in HEDIS, analytical tools, and effective communication skills. Join a team dedicated to improving healthcare quality and making a difference in the community.

Benefits

Medical, dental, and vision coverage

Retirement savings account with employer match

Generous paid time off programs

Tuition/professional development reimbursement

Relocation assistance

Discounted tuition at Mount Carmel College of Nursing

Employee Referral Rewards program

DailyPay option for eligible colleagues

Qualifications

• Minimum of five years of HEDIS and technical experience.
• Requires thorough knowledge of NCQA and HEDIS.

Responsibilities

• Designs and implements processes for managing diverse data sets.
• Develops tools and dashboards to track quality and Stars performance.
• Provides statistical and analytical support to department staff.

Skills

Effective communication

Analytical tools

Project execution

Education

Bachelor's Degree

Tools

SAS

Excel

SQL

Power BI

Tableau

Job description

Employment Type:

Full time

Shift:

Day Shift

Description:

Successful candidates will possess at least 5 years of HEDIS and technical experience. A thorough understanding of NCQA and HEDIS is required. Knowledge of Medicare Stars—including CAHPS, HOS, Part D, and operational measures—is strongly preferred.

Why MediGold?

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

About the job:

The Lead Quality/Stars HEDIS and Technical Analyst . Designs and implements processes and solutions for managing diverse data sets used in data mining, analysis, modeling, and prediction to support informed business decisions. Uses statistical analysis, querying, and reporting techniques to create solutions. Develops tools, algorithms, dashboards (Tableau), and queries to track and enhance quality and Stars performance. Works in collaboration with the others in the organization to develop strategies for achieving a 5 Star rating and is responsible for report/dashboard creations, data verification and, QA in compliance with the Plan requirements and CMS guidelines.

What we are looking for:

• Education: Bachelor's Degree required
• Experience: Minimum of five (5) years of HEDIS and technical experience
• Effective communication skills and ability to work collaboratively with multidisciplinary teams
• Knowledge and understanding of analytical tools, such as SAS, Excel, SQL
• Requires experience with effective/skillful project execution.
• Requires demonstrated experience/ability to work on multiple assignments simultaneously.
• Mastery of relational database theory include SQL and at least one major RDBMS
• Well versed in Big Data scenarios and applications.
• Experience with multiple analytics delivery tools, methods, and platforms including Power BI and/or Tableau.
• Requires thorough knowledge of NCQA and HEDIS.
• Knowledge of Medicare Stars (CAHPS, HOS, Part D & Operational measures) strongly preferred

What you will do:

• Develops and maintain production reporting capabilities. Monitor the timely and accurate production and distribution of all standard and special user-generated reports.
• Provides statistical and analytical support to the department staff. Utilizes SAS, SQL, SOURCE and other statistical based software packages to extract and analyze the data required by the department for both continuing and special needs.
• Facilitate business requirements and define parameters of more complex analytic projects
• Research and investigate key business problems through quantitative analyses of healthcare cost and quality data.
• Develop analytic dashboard to track performance of access to care, clinical quality and consumer experience metrics and to predict the performance trending in Medicare population
• Partners with technical teams to design and improve Medicare data intake and storage infrastructure to enable efficient analytics
  • Ensures plan meets the CMS and NCQA requirements for HEDIS rate production and required deadlines for HEDIS reporting
  • Provide analytical interpretation of Star/HEDIS reporting, including executive summaries, to plan and provider groups

Position Highlights and Benefits:

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!

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Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.