HEDIS Business Information Consultant

Location: This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.

Associates are required to live within a 50-mile radius and a 1-hour commute to one of our Elevance Health major office (PulsePoint) locations. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.

The HEDIS Business Information Consultant is responsible for serving as an expert in data analysis, reporting and formulating recommendations, and providing guidance to other data analysts. 

The position is part of the Enterprise HEDIS Analyst Team. It will be responsible for working with management and peers on the end-to-end HEDIS submissions for a grouping of contracts, audit activities, benchmarking, testing, measure validation, IDSS/PLD submission, state-required reporting, and health plan liaison.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Creates and maintains databases to track business performance.

• Analyzes data and summarizes performance using summary statistical procedures.

• Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.

• Creates and publishes periodic reports, as well as any necessary ad hoc reports.

• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

• May make recommendations based on data analysis.

• Provides analytic consultation to other business areas, leadership, or external customers.

• Data analysis and reporting encompasses a much higher level of complexity.

• Use tools to enable HEDIS to measure deep dives and data quality review to improve HEDIS Ratings.

Minimum Requirements:

• Requires a BS/BA degree in a related field and a minimum of 5 years’ experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Experience with relational databases and knowledge of query tools and statistical software is strongly preferred including SQL and TOAD for Oracle.

• The ability to manipulate large sets of data is strongly preferred.

• Strong analytical, organizational, presentation, and problem-solving skills strongly preferred.

• Excellent training and communication skills preferred.

• Understanding multiple data sources and formats and utilizing multiple data systems to analyze HEDIS results.

• Advanced knowledge of HEDIS specifications, medical record review process including the sample and chase creation, and data analysis of HEDIS rates.

• Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions.

• Experience testing HEDIS measures and validating HEDIS Results in HEDIS software. 

• Ability to articulate complex HEDIS measures.  

• Experience working with State and National HEDIS auditors.

• Experience working with NCQA, CMS, and State regulatory agencies; knowledge of NCQA vendors.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $84,056.00 to $166,150.00.

Locations: California; Colorado; District of Columbia (Washington, DC); Illinois; Maryland; Minnesota; Nevada; New York; Washington State.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.