EmblemHealth

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

EmblemHealth • $110K — $130K *
New York, NY 10025In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree in analytical/quantitative field such as healthcare management, finance, or applied stats.
  • Master's Degree preferred.
  • 5 - 8+ years of relevant professional experience required.
  • 5+ years of experience in managed care/healthcare analytics required.
  • Advanced knowledge of HEDIS and Medicare Stars metrics is essential.
  • Proficient in Microsoft Office Suite and relational database applications (e.g., SAS, R, SQL).
  • Experience automating processes using programming languages such as Python or VBA.

Responsibilities

  • Develop, implement, and manage reporting and reconciliation workflows.
  • Lead medical trend studies to support quality initiatives.
  • Identify and improve data issues affecting quality reports and metrics.
  • Collaborate with IT to ensure digital readiness for data standards like FHIR.
  • Engage with vendors to source new clinical data ingestion options.
  • Conduct data mining and reporting for internal and external stakeholders.
  • Develop and maintain automated dashboards and measure profiles using visualization tools.

Benefits

  • Opportunities for professional growth and development.
  • Collaborative work environment with cross-functional teams.
  • Engagement with cutting-edge healthcare analytics and digital initiatives.
Full Job Description
Summary of Position

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)
  • Strong communication skills (verbal, written, presentation, interpersonal) (Required)
  • Demonstrated self-starter with ability to develop projects end to end independently (Required)

About EmblemHealth

EmblemHealth is a non-profit health insurance company based in New York City. It is one of the largest non-profit health insurers in the United States, serving over 3 million people. EmblemHealth offers a range of health insurance plans, including HMO, PPO, and EPO plans, as well as Medicare and Medicaid plans. The company also offers wellness programs and disease management services. EmblemHealth was formed in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). The company has offices in New York City and Albany, New York.
Learn more about EmblemHealth
Size
3,000 employees
Industry
Healthcare
Net Income
-$100 million
Founded
2006
5 Year Trend
-5%
Revenue
$10 billion
NASDAQ
* Ladders Estimates

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