Quality Analyst

Position Objective:

The Quality Analyst – Risk Adjustment (“Quality”) and HEDIS (Healthcare Effectiveness Data and Information Set) is responsible for ensuring the accuracy and effectiveness of Quality and HEDIS processes within the organization. This role involves analyzing data, identifying trends, conducting quality audits, and supporting quality improvement initiatives. The ideal candidate will have a strong background in Quality and HEDIS processes related to Medicare Advantage, Traditional Medicare, Medicaid, and Commercial healthcare programs, with a keen eye for detail and analytical skills.

Responsibilities:

• Data Analysis and Reporting:
• Analyze Quality and HEDIS data for Primary Care Clinics to ensure accuracy and identify trends or discrepancies.
• Prepare detailed reports on data quality, performance metrics, and areas for improvement.
• Develop and maintain dashboards and visualizations to support data-driven decision-making.
• Quality Audits and Monitoring:
• Conduct regular audits of Quality and HEDIS processes to ensure compliance with regulatory requirements and organizational standards.
• Identify and document issues or discrepancies in data collection, documentation, and reporting.
• Collaborate with team members to resolve audit findings and implement corrective actions.
• Process Improvement:
• Evaluate current Quality and HEDIS processes for Primary Care Clinics to identify opportunities for efficiency and effectiveness improvements.
• Recommend and implement process changes to enhance data accuracy, reduce errors, and improve overall quality.
• Support quality improvement initiatives by providing data insights and recommendations.
• Compliance and Standards:
• Ensure adherence to all relevant regulations and guidelines related to Quality and HEDIS, including CMS and NCQA standards.
• Monitor changes in regulatory requirements and industry best practices, and adjust processes accordingly.
• Develop and update documentation and policies to reflect compliance with current standards.
• Collaboration and Support:
• Work closely with Clinic Operations teams to provide analytical support and insights.
• Assist in the development and delivery of training programs related to data accuracy and quality standards.
• Serve as a point of contact for data-related inquiries and support internal stakeholders in understanding data findings.
• Documentation and Communication:
• Maintain accurate records of quality analysis activities, audit findings, and process improvements.
• Communicate findings and recommendations to management, Clinic Operations teams, and other stakeholders in a clear and actionable manner.
• Prepare presentations and reports for senior leadership and other relevant parties.

Position Requirements/ Skills:

• Bachelor’s degree in healthcare administration, public health, business administration, or a related field.
• Minimum of 1-2 years of experience in Quality, HEDIS operations, or a related field.
• Strong knowledge of Quality methodologies, HEDIS measures, and regulatory requirements.
• Proven experience in data analysis, quality auditing, and process improvement.
• Excellent analytical, problem-solving, and critical thinking skills.
• Strong communication skills, with the ability to present data findings and recommendations clearly to various audiences.
• Detail-oriented with a strong focus on data accuracy and quality.

Physical Requirements:

• Ability to remain in a stationary position, often standing or sitting for prolonged periods of time
• Communicating with others to exchange information
• Repeating motions that may include the wrist, hands, and/or fingers
• Assessing the accuracy, neatness, and thoroughness of work assigned
• Must be able to lift at least 15lbs at times

Key Attributes/ Skills :

• Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals
• Demonstrated ability to handle data with confidentiality
• Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision
• Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
• Excellent written and verbal communication skills; must be comfortable communicating with external/internal stakeholders, providers, and health plans
• Strong interpersonal and presentation skills
• Strong critical thinking and problem-solving skills
• Must be results-oriented with a focus on quality execution and delivery
• Appreciation of cultural diversity and sensitivity toward target patient populations