Sr. Analyst, Digital HEDIS & Quality Analytics

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

Provide analysis, reporting, and predictive modeling to support the quality department digital HEDIS strategy under the quality measurement analytics team. Implement automation of manual reporting and analysis of business implications and trends. Automate 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

• Implement reporting and reconciliation workflows and document processes.
• Responsible for 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.
• Work with IT and others to plan and execute digital readiness, including readiness for FHIR.
• Work 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.
• Develop complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
• Maintain automated quality dashboards and measure profiles utilizing data visualization tools.
• Provide analytical and technical support for design, development and maintenance of quality improvement and wellness initiatives. Build self-service reports to be used by the quality department.
• 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
• 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 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)