Expert HEDIS Business Analyst - Remote

Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today’s healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve.

At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders.

Together, we can transform healthcare and enable smarter care for millions of people.

Veradigm Payer

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm Payers :

• Deliver insights to drive quality outcomes cost-effectively
• Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
• Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Job Summary

The Expert HEDIS Business Analyst will assist our organization as a subject-matter-expert in payer quality measure reporting and analytics, working within a team responsible for the support, maintenance and product strategy for a suite of quality solutions.

Essential Functions

• Assist with the HEDIS, QRS and STARs support for multiple plans through annual reporting and year-round analytics.
• Conduct research for customer inquiries specific to HEDIS Submissions process
• Facilitate customer meetings to deliver research findings or ad hoc reporting
• Develop business cases and requirements for new products and current product enhancements.
• Conduct and document UAT for analytics and reporting solutions.
• Represent Quality team in collaboration with other internal teams for continual process improvement initiatives to simplify and enhance the customer experience.
• Research and maintain awareness of NCQA and CMS regulatory guidance and changes, providing expert interpretation for impacts to products and customers.
• Contribute to the mentoring and training of other team members.

Job Requirements

• Bachelor’s degree or equivalent combination of education and work experience
• Minimum 4 years of experience, and strong working knowledge of, analyzing and interpreting HEDIS administrative and hybrid measure data in a vendor or health plan setting.
• Minimum 4 years of experience actively participating in the HEDIS annual submission process in a vendor or health plan setting.
• Strong working knowledge of NCQA, CMS and State reporting processes and requirements.
• Working knowledge of the HEDIS abstraction process from sampling through to final rates
• Up to 10% travel may be required.

Knowledge, Skills and Abilities

• Extensive experience in healthcare industry, with a focus on quality reporting and analytics.
• Advanced knowledge and in-depth understanding of HEDIS, QRS and STARS technical specifications.
• Experience working with healthcare data analytics.
• Proven technical, analytical, detail oriented, and problem-solving skills.
• Strong written and verbal communication skills.
• Data querying skills, preferably SQL
• Professional and interpersonal.
• Self-initiative and leadership.
• Ability to work within a team environment.
• Ability to interface with both external and internal personnel at all levels.

Compliance

Job responsibilities include fostering the Company’s compliance with all applicable laws and regulations, adherence to the Code of Conduct and Compliance Program requirements, policies and procedures.

Compliance is everyone’s responsibility.

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Enhancing Lives and Building Careers

Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development.

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We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve.

The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions.

Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category.

Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada.

Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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