• HEDIS Quality Data Analyst (FEP)

    Location US-IA-Des Moines
    Job ID
    213092
    Category
    Clinical/Provider Support
    Requires Non-Compete?
    No
  • Job Summary

    About the Team: We’re Wellmark’s HEDIS team. We’re data-focused problem solvers. Much of our work supports Wellmark’s Accreditation team and drives initiatives designed to improve health outcomes. We do this by working with Wellmark’s Quality Committee and business partners from across the enterprise. We use data to support programs that contribute to the success of Wellmark maintaining accreditation, ultimately striving to improve our members’ health.

     

    About The Role: Our HEDIS quality data analyst (FEP) will support Wellmark’s quality program (QP) including accreditation, HEDIS and compliance. This individual will be dedicated to and manage core business processes and quality initiatives on behalf of Wellmark’s Federal Employee Program (FEP). A key focus area will be successful HEDIS submissions and assuring compliance with state and federal regulations and accreditation standards. Additionally, this individual will serve as a resource and subject matter expert to stakeholders and leaders within the organization on the QP and HEDIS for FEP.

     

    Ideal candidates are passionate about working with data and understanding the intricacies of business process relating to membership, provider and claims data. They’re inquisitive, seek to understand, and aren’t afraid to ask questions. They’re also skilled at analyzing data, have an eye for details, compliance, and quality – fueled by a passion for work that positively impacts member health improvement. They’re independent workers, but enjoy collaborating with teams to bring initiatives to life. Sound like a fit? Review the qualifications below and apply today!

    Minimum Qualifications Required (all must be met to be considered)

    • Bachelor's Degree or direct and applicable work experience.
    • 4+ years of work experience in quality management, accreditation, or related role from within health care delivery, managed care, or similar clinical or insurance setting. Experience should reflect:
      • Use of data, including a broad understanding of how data is used in health care quality.
      • Ability to use data to drive decisions and report on outcomes.
      • Proficiency with Microsoft Word and Excel. Analytical and data representation proficiency.
    • Excellent analytical, diagnostic problem solving skills. Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions. Must be able to draw defensible conclusions from available information.
    • Ability to incorporate strategic vision/goals when making decisions.
    • Knowledgeable in regulatory standard or regulation review – e.g., NCQA, accreditation standards, governmental regulations, and confidentiality.
    • Strong written and verbal communication skills with the ability to communicate and/or present complex information to stakeholders in a consumable manner.
    • Strong consultation, relationship management, and critical thinking skills. Ability to develop understanding of business acumen and ask meaningful questions in order to effectively influence and consult with stakeholders.
    • Demonstrated success in roles that require strong time management and workflow management skills. Ability to prioritize effectively and manage multiple priorities.
    • Ability to travel 5-10% as needed.

    Hiring Specifications Preferred

    • Bachelor’s Degree.
    • HEDIS experience.
    • Consulting or project management experience with functional knowledge of process improvement, quality improvement and change management.

    Job Accountabilities

    a. In partnership with the Clinical Quality Manager HEDIS, will provide coordination for the Wellmark FEP HEDIS program including measurement process and ensure adherence to audit standards and technical specifications. Collaborate and coordinate work with the contracted Certified HEDIS Software vendor, and independent HEDIS Auditor in the development and execution of business relationships and improving the HEDIS process.

    b. Educate and engage Wellmark internal and external stakeholders on Wellmarks quality management program QMP accreditation, HEDIS and FEP compliance activities. This includes fully informing all appropriate Wellmark staff and appropriate owners of processes of accreditation and compliance requirements, and what specifically is required to stay compliant with required standards.

    c. Identify, recommend and implement quality improvement initiatives that promote the delivery of appropriate identified care, coordinated to preserve member benefit dollars as well as improving member health status, and member satisfaction with Wellmark/FEP.

    d. Provide quantitative and qualitative analysis, identify opportunities for improvement identified and implement with subsequent measurement and analysis of the interventions that equip Wellmark, members and providers to manage the health care of our members, or internal processes or policies.

    e. Develop quality improvement reports, dashboards and present to the Quality Committee, FEP, other stakeholders and internal business partners.

    f. Support the annual HEDIS program requirements to include gathering, managing data and reporting of measures. And related activities.

    g. Comply with regulatory standards, accreditation standards, HEDIS Technical Specifications, FEP requirements and internal policies and remain current with the standards pertinent to the QMP. Will support assigned accreditation/audit functions during surveys as applicable and appropriate for FEP.

    h. Develop and implement quality improvement work plans, evaluate and report findings to Quality Committee and FEP at required intervals. Provide support of the Wellmark Quality Committee. Serve as a Wellmark representative on FEP BCBSA workgroups and committees. Attend and/or provide staff support for other assigned committees.

    i. Provide support to the Network Administrative leadership team by interacting with Wellmark corporate compliance team and FEP to assess impacts from state and federal regulatory requirements, and BCBSA mandates. This includes maintaining the compliance matrix specific to the Quality Management Program, and communicating to leaders when new or existing compliance activities need assessed or completed.

    j. Support the Business Continuity Planning and preparation process.

    k. Other duties as assigned.

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