Expert HEDIS Business Analyst - REMOTE

Atlanta, GA, United States

Welcome to Veradigm! Our Mission is to be the most trusted provider of innovative solutions that empower all stakeholders across the healthcare continuum to deliver world-class outcomes. Our Vision is a Connected Community of Health that spans continents and borders. With the largest community of clients in healthcare, Veradigm is able to deliver an integrated platform of clinical, financial, connectivity and information solutions to facilitate enhanced collaboration and exchange of critical patient information.

Veradigm Payer

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions From Veradigm Payers

Deliver insights to drive quality outcomes cost-effectively

Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange

Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Location: REMOTE

Overview

The Expert HEDIS Business Analyst will assist our organization as a subject-matter-expert in payer quality measure reporting and analytics, working within a team responsible for the support, maintenance and product strategy for a suite of quality solutions, as well as supporting the Quality Assurance (QA) team.

What You Will Contribute

Assist with the HEDIS, QRS and STARs support for multiple plans through annual reporting and year-round analytics.

Conduct research for customer inquiries specific to the suite of quality solutions.

Facilitate customer meetings to deliver research findings or ad hoc reporting.

Develop business cases and requirements for new products and current product enhancements.

Support the work of the QA team.

Work in conjunction with the Software Development teams to facilitate business requirements feasibility and resource estimates.

Represent Quality team in collaboration with other internal teams for continual process improvement initiatives to simplify and enhance the customer experience.

Research and maintain awareness of NCQA and CMS regulatory guidance and changes, providing expert interpretation for impacts to products and customers.

Contribute to the mentoring and training of other team members.

The Ideal Candidate Will Have

Bachelor’s degree or equivalent combination of education and work experience

Minimum 4 years of experience, and strong working knowledge of, querying, analyzing and interpreting HEDIS administrative and hybrid measure data in a vendor or health plan setting.

Minimum 4 years of experience actively participating in the HEDIS annual submission process in a vendor or health plan setting.

Strong working knowledge of NCQA, CMS and State reporting processes and requirements.

Working knowledge of the HEDIS abstraction process from sampling through to final rates

Up to 10% travel may be required

Knowledge, Skills And Abilities

Extensive experience in healthcare industry, with a focus on quality reporting and analytics.

Advanced knowledge and in-depth understanding of HEDIS, QRS and STARS technical specifications.

Experience working with healthcare data analytics.

Proven technical, analytical, detail oriented, and problem-solving skills.

Strong written and verbal communication skills.

Data querying skills, preferably SQL

Familiarity with SAFe is advantageous.

Familiarity with Data Bricks is advantageous.

Professional and interpersonal. bonus

Self-initiative and leadership.

Ability to work within a team environment.

Ability to interface with both external and internal personnel at all levels.

Compliance Job responsibilities include fostering the Company’s compliance with all applicable laws and regulations, adherence to the Code of Conduct and Compliance Program requirements, policies and procedures. Compliance is everyone’s responsibility.

Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network . Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.

Visa Sponsorship is not offered for this position.

Veradigm’ policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

From a "VEVRAA Federal Contractor" We request Priority Referral of Protected Veterans

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