Healthcare HEDIS Reporting Lead

Job Overview

The Healthcare HEDIS Reporting Lead 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. This role applies both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan level.

Work Schedule

• Remote.
• Monday through Friday from 8:00a EST to 5:00p EST.

Responsibilities

•  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.
• Represents HEDIS team in collaboration with internal departments for HEDIS improvement.
• Supports 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.
• Provides 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.
•  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.

Education & Experience

• Bachelor's Degree required in Business Management and/or Information Systems
• Minimum 3 years working experience in the healthcare 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.
• Attention to detail and strong organizational skills.

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.

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.