Responsibilities:

• Supports corporate, plan-level, and departmental strategies and goals for HEDIS process external data feeds to optimize HEDIS performance.
• Meets this standard by effectively applying both business knowledge and technical expertise to support business initiatives and solve business problems.
• The Quality Data Strategist Sr. Quality Senior Analyst works as an internal consultant performing data analytics and forensic data investigations for stakeholders.
• Advises stakeholders on data quality standards, interpretation of results, and options for improved analysis.
• Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all LOBs.
• Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues, and facilitates resolution of such issues.
• Supports identification of training opportunities and assist in mentoring and training associates in advanced analytics. Position interacts with associates at all levels in the organization, external clients and vendors.
• Actively collaborates with the HEDIS team on longitudinal projects
• Able to assimilate into team within minimum amount of assistance
• Assures the ongoing high performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers
• Experience and ability to utilize a certified HEDIS software, SAS, and FACETS required. SQL experience preferred.
• Mentors and develops junior analysts; assisting them in the development of their skills and acquisition of new skill-sets.
• Provides leadership and oversight in the development and implementation of business and technical solutions utilized to complete reporting requirements while ensuring that the report completion process remains both accurate and efficient.
• Through report review or verification process, identifies and implements process or system enhancements that may lead to improved data integrity, efficiencies or consistencies. Identifies appropriate internal or external contacts and coordinates development of work groups and plans of action to ensure successful resolution and implementation of enhancements identified.
• Participates in inter-departmental teams to ensure that Regulatory Reporting needs are communicated and data is not compromised when business procedures are modified and if affected, works with team to develop alternate solutions to ensure data integrity is not impacted.
• Develops and maintains a strong working relationship with regulatory agencies, joint venture contacts or subcontractors by attending required meetings and/or on-site visits.
• Participates in peer-review (QA) of reports.
• Reviews and approves reporting, presents reporting and obtains necessary approvals from the Director, Regulatory Reporting or other business owners as required.
• Reviews, researches and coordinates prompt responses to correspondence and inquiries from stakeholders, clients or regulatory agencies.

Education/Experience:

• Bachelor’s Degree required – preferably with a concentration in health care related field, Information Technology, or mathematics.
• Master’s Degree preferred.
• 2 years HEDIS experience.
• Minimum 5 years of work experience in healthcare and/or managed care.
• Familiar with clinical ontologies and code sets: SNOMED, LOINC, ICD, etc.
• Background in use of statistical process control techniques
• Familiarity with HEDIS technical specifications.
• Background in database design.
• Strong analytical skills.
• Strong skills in at least one database query language (SAS, SQL, Tableau, and/or Python).
• Foundation in at least one programming language preferred (Python, Java, C++) preferred.
• Working knowledge of National Interoperability and Clinical Data Exchange standards including HL7 standards and healthcare related EDI technologies.
• Familiarity with HEDIS technical specifications.
• Alignment with the AmeriHealth Caritas mission of helping people get care, stay well and build healthy communities with a special concern for those who are poor.

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