Temporary, HEDIS Analyst

This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time.

Position Summary:

The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured through critical measures. The role supports efforts of the organization's Network and Provider Contracting department and will have regular interaction with relevant internal Clinical, Quality, and BI departments, while frequently interfacing with Providers within CCA's Network. The objective of this role is to reduce and or prevent loss of revenue due to below-benchmark performance on critical Quality measures.

Priority measures may shift year-to-year as dictated by organizational performance trends and the Network's ability to impact these trends.

This role's three key areas of focus will be to:

1. Identify underperforming Providers

2. Work cross-functionally to determine reasonable expectations and solutions

3. Facilitate and implement Provider specific and/or Network improvement initiatives

Current year priority measures include Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH)

The ideal candidate will have strong organizing skills, analytic capabilities, and the ability and comfort with working across internal and external stakeholders to coordinate initiatives and projects affiliated with Quality performance improvement.

Supervision Exercised:

• No, this position does not have direct reports.
  

Essential Duties & Responsibilities:

• Conduct weekly tracking of Quality/ HEDIS metrics, specifically focused on Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH) data:
  • Work with BI, Quality, and BH teams to evaluate and build data sources delivering accurate performance data and reliable actionable data
  • Track performance trends on a weekly basis, evaluating member-specific and provider level details
  • Identify reasons for low and high performance; which providers are doing well and which are struggling? Which diagnosis setting is leading to the highest number of missed opportunities for a timely Initiation visit?
  • Identify which Network providers are excelling and which are underperforming.
• Design IET and FUH data formats that are user-friendly and can be shared with relevant Network Providers, including those with delegated arrangements
  • Review YTD claims files on a monthly/quarterly basis to identify errors and address accordingly with appropriate SMEs
• Meet with select Providers and HHs to discuss IET and FUH performance and workshop improvement interventions with short term and long-term goals
  • Understand barriers and challenges providers are experiencing
  • Work with high performers to build a comprehensive list of tips and best practices that can be shared with lower performing entities and with CCA's internal BH and Care Partnership teams
  • Determine regular cadence to check-in with lower performing HHs and Providers to get updates on their progress
• Partner with CCA Clinical teams and programs to build a roll out initiatives aimed at leveraging Providers to improve Quality measures
• Train and Education Provider Network on the measures
  • Organize trainings, working with Quality and Clinical teams to build reference documents and aggregate content for webinars; work with appropriate SMEs to ensure materials and trainings are modified for different Provider audiences

Working Conditions:

• This is a remote role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday.

Member Facing:

NO: The job duties do not involve face-to-face contact with members, even for staffing coverage purposes.

Required Education (must have):

• Bachelor's degree or equivalent experience within healthcare project management, HEDIS and STARs measures, population health, and the health plan space

Desired Education (nice to have):

Master's degree within healthcare management and administration, public health, business administration or relevant field

MA Health Enrollment (required if licensed in Massachusetts):

• No, this is not required for the job.

Required Experience (must have):

• 5+ years of experience working within community-based health and/or managed care

Desired Experience (nice to have):

• Experience working within community-based health and/or health plan organization to lead Network projects, clinical implementation, and/or population health initiatives

Required Knowledge, Skills & Abilities (must have):

• Strong organizing skills and analytic capabilities
• Demonstrated understanding of the duals programs and Network quality measures
• Analytic mindset with the ability to work within larger data sets to identify trends and produce actionable recommendations
• Proven experience and understanding of HEDIS and Health Plan quality initiatives; familiarity with behavioral health KPIs such as IET and FUH
• Results oriented and self-motivated with the ability to work independently and collaboratively across internal and external stakeholders
• Has the ability to thrive in high pressured environments, adjust to shifting priorities, and multi-task
• Working knowledge of project/program management practices
• Strong verbal communication skills with the ability to present data insights to various audiences, facilitate meetings and project plans
• Proficiency with spreadsheets and databases, including excel, PowerPoint, and word
• Team player with interest and ability to pivot as needed to meet the larger performance goals of the Network departments

Required Language (must have):

• English