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Description
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 Philadelphia, 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:
Implements Healthcare Effectiveness Data and Information Set (HEDIS) project plan and meets all requirements of National Committee for Quality Assurance (NCQA) and regulatory reporting, which includes project monitoring, data collection, quality control, and final reporting. Applies both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan level.
- In collaboration with management, develop and manage the annual HEDIS project plan inclusive of HEDIS based regulatory reporting for the enterprise.
- Support HEDIS onsite audit.
- Facilitates relationship with Medical Record Review (MRR) vendor for all technical aspects of annual MRR projects.
- Represent HEDIS team in collaboration with internal departments for HEDIS improvement.
- Support HEDIS Road Map and all other documents required by auditors.
- Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.
- Ensures all HEDIS supplemental data sources are represented and reported accurately for data completeness.
- Improves HEDIS reporting process by leading ongoing “lessons learned” processes for internal operational improvement.
- The HEDIS Lead will provide managerial guidance to HEDIS Analysts and HEDIS Analysts Sr.’s with meeting deliverables.
- Leads ongoing enhancements to the department’s HEDIS analytics offerings and solutions.
- Is fully oriented to the strategic goals and initiatives of the Department, Company, individual Plans, and industry. Effectively translates goals into actionable work plans for individual staff.
- Deals proactively and tactfully with difficult customers, viewing such situations as opportunities to continually build stronger working relationships.
- Adjusts readily to changing priorities and assignments, and manages staff workload accordingly.
- Other duties as required and/or assigned.
Education & Experience
- Bachelors’ degree required in Business Management and/or Information Systems
- Minimum 3 years working experience in the health care industry.
- Minimum 1 year of Project Management and HEDIS knowledge required.
- Strong SQL and big data / cloud programming skills preferred.
- Extensive knowledge of Microsoft Office.
- Ability to manage multiple, complex projects with strict deadlines.
- Excellent verbal and written communication skills.
- Strong desire for accuracy, a concern for detail.
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