Location: This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.
Associates are required to live within a 50-mile radius and a 1-hour commute to one of our Elevance Health major office (PulsePoint) locations. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.
The HEDIS Business Information Consultant is responsible for serving as an expert in data analysis, reporting and formulating recommendations, and providing guidance to other data analysts.
The position is part of the Enterprise HEDIS Analyst Team. It will be responsible for working with management and peers on the end-to-end HEDIS submissions for a grouping of contracts, audit activities, benchmarking, testing, measure validation, IDSS/PLD submission, state-required reporting, and health plan liaison.
How You Will Make An Impact
Primary duties may include, but are not limited to:
- Creates and maintains databases to track business performance.
- Analyzes data and summarizes performance using summary statistical procedures.
- Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
- Creates and publishes periodic reports, as well as any necessary ad hoc reports.
- May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
- May make recommendations based on data analysis.
- Provides analytic consultation to other business areas, leadership, or external customers.
- Data analysis and reporting encompasses a much higher level of complexity.
- Use tools to enable HEDIS to measure deep dives and data quality review to improve HEDIS Ratings.
Minimum Requirements
- Requires a BS/BA degree in a related field and a minimum of 5 years’ experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, & Experiences
- Experience with relational databases and knowledge of query tools and statistical software is strongly preferred including SQL and TOAD for Oracle.
- The ability to manipulate large sets of data is strongly preferred.
- Strong analytical, organizational, presentation, and problem-solving skills strongly preferred.
- Excellent training and communication skills preferred.
- Understanding multiple data sources and formats and utilizing multiple data systems to analyze HEDIS results.
- Advanced knowledge of HEDIS specifications, medical record review process including the sample and chase creation, and data analysis of HEDIS rates.
- Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions.
- Experience testing HEDIS measures and validating HEDIS Results in HEDIS software.
- Ability to articulate complex HEDIS measures.
- Experience working with State and National HEDIS auditors.
- Experience working with NCQA, CMS, and State regulatory agencies; knowledge of NCQA vendors.
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