Senior HEDIS Technical Analyst - Remote

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

Job Description

Key Outcomes:

• Interprets, creates, processes, and reports healthcare measures from various measure steward resources including but not limited to Centers for Medicare and Medicaid Services (CMS); National Committee for Quality Assurance (NCQA) and the Defense Health Agency (DHA).
• Translates licensed or documented metrics definitions into technical queries with appropriate cohorts and calculations
• Analyzes workflows and understand policies, procedures, and constraints of the clinical or business operations related to reporting requirements.
• Documents operational & report specifications.
• Performs complex quality assurance testing along with writing and executing queries for enhanced and complex medical data access.
• Plans, develops, and documents design and deployment processes, workflows, and results.
• Provides expertise in electronic clinical data capture and the development of electronic clinical data reporting and analysis.
• Oversees transition to digital quality and management of associated vendors
• Troubleshoots production reporting issues, identify root causes and implement necessary coding updates.
• Validates data sources, including Claims, Electronic Health Data, and Electronic Health Records, for relevance, integrity, and accuracy. E.g., HL7, CCD.
• Strongs focus on working with peers as a team and ensuring documentation and training are thorough to allow for a smooth transition to the operations team.
• Quality assurance and controls of healthcare measures created and published for THC customers.
• Ensures proper use and protection of information assets by complying with the organization’s information privacy and security policies to protect assets from unauthorized access and by reporting any security events or potential events or other security risks to the organization.
• Other duties and responsibilities, as assigned.

Education/Experience:

• Bachelor’s degree in health sciences, Master’s degree preferred.
• 5+ years of experience in the health care industry, in HEDIS and/or quality improvement.
• Experience in managed care health services environment
• Experience programming HEDIS or HEDIS like measures.
• NCQA and HEDIS Experience.

Required License(s) and/or Certification(s):

• Certified Professional in Healthcare Quality, preferred.

Skills/Knowledge/Competencies (Behaviors):

• Demonstrated knowledge of data collection, transformation and quality assurance.
• Ability to extract, cleanse, integrate medical and pharmacy claims and membership data from various platforms and sources.
• Excellent communication, organization and writing skills.
• Ability to effectively prioritize work, multi-task, and achieve goals on time; work independently and to self-motivate.
• Excellent critical thinking skills.
• Keen attention to detail.
• Ability to work effectively and collaboratively with internal and external stakeholders.
• Knowledge of, and skills in, data collection, analysis, and presentation.
• Excellent oral and written communication skills.
• Must demonstrate integrity, sound judgement and strong interpersonal skills.
• Strong knowledge of medical terminology.
• Strong clinical knowledge and understanding of evidenced-based practice principles and the ability to define appropriate sources for standards of care.
• Must be able to address quality issues with tact and diplomacy.
• Proficient use of MS Office with a focus on Excel and report writing software.
• Proficiency in use of electronic medical records and computer applications.
• Ability to use data to make decisions.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org