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QSD (HEDIS®) Analyst - Telecommute

Position Description

We have an opportunity for a QSD Analyst. This position is available for telecommuters. Our Quality Operations Engagement groups are vital to our success and are leaders in driving the future growth of UnitedHealth Group. Success in these careers relies on many factors-your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Monitor on-going progress of business processes
    • Monitor compliance against relevant process requirements (e.g., turnaround time)
    • Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
    • Ensure all NCQA, CHCA, FEHB, State and other HEDIS® reporting requirements and deadlines are met
  • Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities in order to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
    • Completion of the Optum RFI to define HEDIS® reporting requirements
    • Submission of the NCQA Health plan Roadmap General Information, Appendix and Attestation
    • Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
    • Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS® project (Initial, Refresh, Final)
    • Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update rates
    • Perform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirements
    • Complete project chase status updates, chase activations, query exports and data analysis to support rate improvement and project completion
    • Coordinate with medical record vendors on file loads and resolving technical project issues
    • Confirmation of all hybrid exclusions entered into HEDIS® software, coordinating clinical review when necessary
    • Complete all HEDIS® software upgrade steps as required
    • Create and validate all final hybrid frozen counts and deliver to CHCA
    • Complete all final hybrid project close steps, including validation of all exclusions and QA of all final data and rates
    • Complete all final admin and hybrid project processing
    • Creation of IDSS exports and submission to NCQA
    • Creation of PLD exports and submission to CHCA and/or CMS
    • Submission of State required reporting
    • Collaborate with CDSM to ensure all supplemental data submissions (SDS) files are obtained for State Registries
    • Coordinating look-up access activities for State Registries where data files must be supplemented in hybrid efforts
    • Coordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are met
  • Analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
    • Participate in analysis of project outcomes to generate data driven recommendations for process improvement
    • Lead and participate in workgroups to implement process improvement and/or in preparation to meet business requirements
    • Participate in HEDIS® software system testing efforts to ensure project preparedness
    • Use a process driven approach to identify root cause and process improvement opportunities
  • Demonstrate and remain current in understanding of relevant regulations and systems
    • Complete all required training for job role and stay current on all HEDIS® technical specifications and software systems
    • Develop proficiency in HEDIS® software tools and HEDIS® and other required quality metric reporting specifications
    • General knowledge of HEDIS® impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
  • Summarize and communicate proposed solutions with the appropriate audiences
    • Resolve all CHCA (Auditor) Issue Log concerns for projects assigned
  • Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
    • Timely escalation of all issues and barriers to Manager, QSD Projects (MQP)
  • Assesses and interprets customer needs and requirements.
  • Identifies solutions to non-standard requests and problems.
  • Solves moderately complex problems and/or conducts moderately complex analyses.
  • Works with minimal guidance; seeks guidance on only the most complex tasks.
  • Translates concepts into practice.
  • Provides explanations and information to others on difficult issues.
  • Coaches, provides feedback, and guides others.
  • Acts as a resource for others with less experience

Sure, you'll need to diagnose process improvement opportunities and develop solutions. The difficulty is in knowing the right questions to ask. You will solve complex problems as you serve as a resource to others on your elite team. You'll be expected to find better, more efficient ways of doing things and collaborate effectively with multiple stakeholders.

Required Qualifications:

  • Associates Degree or equivalent related experience
  • Excellent written and verbal communication skills
  • 6+ months of HEDIS® or CMS STARS experience
  • Demonstrated ability to manage and prioritize deliverables
  • Healthcare/Healthplan experience
  • Strong proficiency with data manipulation and analysis with MS Excel (pivot tables, macros, formulas)
  • Strong experience with MS Word for business communications
  • Intermediate to Advanced level of experience with Outlook and PowerPoint
  • Experience conducting moderately complex analysis with large data sets to identify trends and/or potential risk

Preferred Qualifications:

  • Bachelor's Degree or higher
  • 2 or more years of HEDIS operations experience
  • Strong knowledge of managed care requirements related to clinical quality
  • Experience working with HEDIS medical record vendors
  • Proficient with certified HEDIS® software
  • Experience using CMS, NCQA referencing websites

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: HEDIS® , NCQA, CHCA, FEHB, Excel, Analyst, SDS, MRR, IDSS, QSD, telecommute, telecommuter, telecommuting

QSD (HEDIS®) Analyst - Telecommute

Lake Oswego, OR
Full Time

Published on 08/01/2019