HEDIS Analyst Sr

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

Responsible for the support, maintenance, and developmental strategies for HEDIS throughout the AmeriHealth Caritas Family of Companies. Ensures the maximum level of data accuracy, integrity, consistency, and completeness in the various internal and external data sources used for end-user reporting purposes (e.g., Oracle data warehouses, various supplemental data sources).  Identifies data-related issues, and conducts root cause analyses; facilitates resolution of known issues by working directly with end-users and IT staff.  Works closely with the Quality Team and Medical Record Review vendors as needed to ensure that the medical charts meet the standards as outlined by HEDIS specifications (understanding provider chase logic).  Assist as needed in the creation and support of the Roadmap, HEDIS audit, and various HEDIS reports including QA.   Establishes business rules for accurate use of reporting data fields.  Identifies new and maintains existing sources of data to ensure the availability of information for reporting purposes.  Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all LOBs.  Develops and executes test processes related to end-user data and databases; documents and tracks data-related issues, and facilitates resolution of such issues.  Supports identification of training opportunities and assist in mentoring and training associates in regards to the HEDIS process and timeline. Position interacts with associates at all levels in the organization, external clients and vendors.
 
Essential Functions include but not limited:

• Manage the HEDIS lifecycle process for multiple plans.
• Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations.  
• Develops and implements data-driven solutions to meet business requirements by producing analytics, reports, and data sets.
• Assist as necessary in the review of medical records.
• In collaboration with the HEDIS manager to develop annual HEDIS project plans and monitor the HEDIS project plans for multiple LOBs.
• Assist in preparation for the HEDIS audit.
• Develop and maintain HEDIS based report to support Quality Initiatives.
• Represent HEDIS team in collaboration with internal departments for HEDIS improvement.
• Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
• Assists as necessary in the HEDIS Road Map and all other documents required by auditors.
• Able to assimilate into team within minimum amount of assistance.
• Assures the ongoing high performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers.
• Experience and ability to utilize a certified HEDIS software.
• Experience reviewing medical records is a plus.

Education/Experience:

• Bachelor’s Degree required with a concentration in health care related field.
• Master’s Degree preferred.
• Minimum 2 years HEDIS experience required, 4 years preferred.
• Minimum 5 years of work experience in healthcare and/or managed care.
• SQL and SAS experience required.  Experience utilizing a certified HEDIS software.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.