Senior HEDIS Analyst

Quality Assurance Park Ridge, Illinois


Description

Position at Clear Spring Health

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

Senior HEDIS Analyst 

Location: Park Ridge, IL 

Company Information

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.

Job Summary 

Reporting directly to the Vice President of IT, as a Senior HEDIS Analyst you will be responsible for the support, maintenance and development of strategies for the HEDIS 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 HEDIS data sets.

Main Responsibilities

  • Identify data-related issues, conduct root cause analyses and facilitate resolution of known issue by working directly with end-users and IT Staff.
  • Work with the Quality and Medical Management team(s) as needed to ensure that 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 and assist as necessary in the HEDIS roadmap and all other documents required by auditors.
  • Ensure all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
  • Be proficient in SQL queries, be able to participate in data mapping of various sources.

Qualifications

  • Bachelor’s degree in healthcare administration, systems/management information systems or related health/IT field. Advanced degree preferred but not required
  • Minimum 2 years of HEDIS experience required, 4 years preferred
  • Minimum 5+ years of work experience in healthcare and/or Medicare
  • SQL and SAS 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