HEDIS Coordination - Data Analyst

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

REMOTE - TEXAS; Applicants physically reside in the state of Texas

Monday - Friday: 8:00 am - 5:00 pm (CST)

Position Purpose: Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas.

• Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results
• Establish and maintain an action plan to improve HEDIS scores
• Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
• Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidences, documentations, and changes
• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
• Conduct quality audit and maintain all data and process controls to ensure compliance
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

Bachelor’s degree in related field or equivalent experience.

3+ years of quality improvement or healthcare related experience is required. Working knowledge of the National Committee on Quality Assurance (NCQA) is preferred.

Working knowledge of HEDIS requirements is preferred.

Preferred Experience:

• 4+ years of analyzing healthcare Quality data, QA databases, EMR systems, and HIPPA regulations - strongly preferred

• Direct work experience with data analysis, interpreting statistical data, assessing HEDIS performance, resolving data quality issues, and tracking compliance trends

• Proficient in writing SQL queries, extracting and interpreting data for stakeholders is a MAJOR PLUS***

• Proficient computer skills utilizing Microsoft Office applications (Excel, Outlook, One Note, Word, Power Point, etc) and be able to navigate between multiple databases

• Organizational skills, time management, agility AND adaptability skills are CRITICAL skills in this role meet KPIs and Quality initiatives

• Experience utilizing multiple avenues of communication (i.e, Email, Phone, Video, and Conferencing Applications)

• Experience and working knowledge with HIPPA regulations, healthcare compliance standards (NCQA, InterQual), and Medicaid insurance practices and regulations is preferred

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act