Supports corporate and departmental strategies and goals for the annual HEDIS submission process. Effectively applies business knowledge and technical expertise to support business initiatives to report clinical quality of care received by members. Works closely with the Quality team to develop year-round strategies to improve quality of care received by members, members' health outcomes. Generates and maintains thorough and accurate documentation related to data sources, business rules, and reporting policies and procedures.
Manage the HEDIS submission lifecycle process for multiple submissions
Identifies, plans, and executes HEDIS submission lifecycle process improvement opportunities
Develops content expertise and experience as a resource regarding the HEDIS submission process, including data sources, measurement, medical records review process and sampling, and annual audit functions
Participates in training to further knowledge, skills and abilities in quality measurement and improvement, and data management
BA/BS in health care administration, public health, or a health care related field
Minimum of one (1) year of HEDIS-specific knowledge and submission experience
Experience using certified HEDIS software
Demonstrated experience in data extraction (SQL) and analytics programming languages (SAS)
Ability to perform beginner to intermediate queries and retrieve and integrate data from multiple tables and/or sources
Demonstrated success with analyzing clinical, claims, pharmacy and encounter data
Foundational knowledge and experience with the health insurance industry, and particularly with clinical quality measurement
Demonstrated effective and long-term success with communicating in writing, verbally and with delivering presentations
Successful project management expertise and experience, a well-developed business sense, the ability to perform in a fast-paced environment, and comfort interacting with internal and external senior leaders are critical to success in the role
Working with minimal direction, initiate projects and demonstrate significant flexibility to coordinate complex activities that are often subject to rapid or extensive changes
About Medical Mutual:
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We are the largest health insurer in Ohio and for over 80 years, we have been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarters building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!
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