Senior HEDIS Data Analyst
Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina. In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.
Reporting directly to the Director of Analytics, as a Senior HEDIS Data Analyst you will be responsible for the support, maintenance and development of strategies for the HEDIS program through Clear Spring Healthcare various Medicare plans. Ensures data accuracy, integrity and completeness in the various internal and external data sources used for end-user reporting. Conduct highly complex quality management, procedural documentation and analysis on key data sets.
- Identify data-related issues, conduct root cause analyses and facilitate resolution of known issue by working directly with end-users, IT Staff, departmental SME’s and third-party vendors.
- Work with the Quality and Medical Management team(s) as needed to ensure that supplemental medical charts meet the standards as outlined by HEDIS specifications.
- Assist as needed in the creation and support of the Roadmap, HEDIS Audit and various HEDIS reports including QA.
- Identifies new and maintains existing sources of data to ensure the availability of information for reporting purposes.
- Manage the HEDIS lifecycle process for all Lines of Business (LOB)
- Assure the accuracy and validity of both source data and results and interpreting results into recommendations.
- Develop annual HEDIS project plans and monitor the HEDIS project plans for all LOBs.
- Take lead in preparation for HEDIS audit data sets and assist as necessary with all other documents required by auditors.
- Ensure all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
- Advanced working knowledge writing SQL queries, with the ability to lead/participate in data mapping of various sources.
- Respond to ad hoc reporting requests as needs arise, and work with all Company departments to identify and meet reporting requirements. Design, test, and execute to meet reporting needs working with business partners. Make recommendations to management/leadership based on business case and analysis.
- Bachelor’s degree in healthcare administration, systems/management information systems or related health/IT field, Master’s degree in related field preferred.
- Minimum 3 years of HEDIS experience required, 5 years preferred
- Minimum 7+ years of work experience in healthcare and/or Medicare
- Advanced SQL experience
- Experience utilizing a certified HEDIS software
- Experience in claim systems
- Strong written and verbal communication skills with sufficient technical and operational capabilities to communicate with multiple teams at every level of the organization.
- The ability to work independently and prioritize
- Other duties as assigned.