Senior HEDIS Operations, Quality Professional
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $89,000 - $121,400 per year
Job Level
Senior
About the role
- Become an expert in HEDIS & Stars specifications, processes, and schedules
- Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and guidance to the enterprise
- Establish and maintain effective professional relationships with key upstream and downstream partners
- Development and maintenance of operational workflows, processes, use of technology and systems
- Support clinical quality improvement by championing continuous improvements to operational processes and systems/tools development
- Partner to drive and oversee comprehensive program to support quality improvements and holistic data capture
- Manage multiple data sets from varying systems to inform resource needs, data value, and report metrics
- Interpretation and presentation of complicated and large data sets to identify trends, data scenarios, and opportunities for improved member health and measure compliance
- Internal and external partnerships to coordinate, guide, direct and oversee day-to-day HEDIS activities, including: contingency planning and mitigation, communications, metrics, reporting and prioritization
- Development, tracking and presentation of metrics to ensure data quality, timeliness, and accuracy
- Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure
Requirements
- Bachelor’s Degree or equivalent experience
- Background in operations and/or project management with strong organizational and critical thinking skills
- Demonstrated ability to articulate ideas effectively (written and verbal) to effectively communicate across teams, levels and functions
- Be agile and adaptable to shifting priorities
- Passionate about contributing to an organization focused on continuous improvement and driving results
- Able to learn and leverage multiple systems and data sets
- Self-starter who assumes accountability for their team’s success and strives to maximize results for the enterprise
- Comfortable working in fast-paced environment with an ability to manage multiple simultaneous time-sensitive deliverables
- Demonstrated excellence in problem solving/critical thinking with exceptional attention to detail
- Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint and Visio
- 3+ years of experience in healthcare, insurance or related industry (preferred)
- Stars or HEDIS Experience (preferred)
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance and many other opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
HEDISStars specificationsdata analysisoperational workflowsdata quality metricscompliance auditingcontinuous improvementproject managementcritical thinkingproblem solving
Soft skills
effective communicationorganizational skillsadaptabilityself-starterattention to detailrelationship buildingteam accountabilityagilitytime managementcollaboration